ENT Evaluation and management of Bell's palsy Chunfu dai Otolaryngology Department Fudan University 复且大学眼耳科医院
Evaluation and management of Bell’s palsy Chunfu Dai Otolaryngology Department Fudan University
ENT Definition Rapid onset of the facial palsy Minimal associated symptoms Spontaneous recovery(80%) The diagnosis is made after the exclusion of other possibility
Definition ◼ Rapid onset of the facial palsy ◼ Minimal associated symptoms ◼ Spontaneous recovery (80%) ◼ The diagnosis is made after the exclusion of other possibility
ENT Etiology Vascular congestion with secondary ischemia to the nerve u Vasospasm would lead to ischemia, nerve edema, and secondary compression within the fallopian canal Viral polycranioneuropathy Herpes simplex virus and herpes zoster virus
Etiology ◼ Vascular congestion with secondary ischemia to the nerve ◼ Vasospasm would lead to ischemia, nerve edema, and secondary compression within the fallopian canal. ◼ Viral polycranioneuropathy ◼ Herpes simplex virus and herpes zoster virus
ENT Clinic features Less common before the age of 15y The incidence in men and women is similar Approximately 6-9% develop recurrent Bell's Palsy Facial paresis alone occurred in 31%0 Completely paralysis in 69%
Clinic features ◼ Less common before the age of 15y ◼ The incidence in men and women is similar ◼ Approximately 6-9% develop recurrent Bell’s Palsy ◼ Facial paresis alone occurred in 31% ◼ Completely paralysis in 69%
ENT Clinic features 71% of patients with completely paralysis achieve a H-B G1 13%aH-b 2 J The remaining 16%in this complete paralysis group have a fair to poor recovery(H-B 3-5)
Clinic features ◼ 71% of patients with completely paralysis achieve a H-B G1 ◼ 13% a H-B G2 ◼ The remaining 16% in this complete paralysis group have a fair to poor recovery (H-B 3-5)
ENT Prognosis All patients with complete or partial paralysis, approximately 85% recover to normal with one year without treatment Patient experienced delayed recovery over 3 months, all developed sequelae Return of at least some facial function was noted in all patients
Prognosis ◼ All patients with complete or partial paralysis, approximately 85% recover to normal with one year without treatment. ◼ Patient experienced delayed recovery over 3 months, all developed sequelae ◼ Return of at least some facial function was noted in all patients
ENT Evaluation of acute facial paralysis House-Brackman grade system Normal: normal facial functionin all areas J, Mild dysfunction: slight weakness noticeable only on close inspection At rest: normal symmetry and tone Motion some to normal movement of forehead Ability to close eye with minimal effort a Ability to move corners of mouth with maximal effort and slight asymmetry No synkinesis, contractur, or hemifacial spasm
Evaluation of acute facial paralysis ◼ House-Brackman grade system ◼ I, Normal: Normal facial functionin all areas ◼ II, Mild dysfunction: slight weakness noticeable only on close inspection ◼ At rest: normal symmetry and tone ◼ Motion: some to normal movement of forehead ◼ Ability to close eye with minimal effort ◼ Ability to move corners of mouth with maximal effort and slight asymmetry ◼ No synkinesis, contractur, or hemifacial spasm
ENT Evaluation of acute facial paralysis House-Brackman grade system I, moderate dysfunction I obvious but not disfiguring difference between two side a No function impairment Noticeable but not severe synkinesis, contracture, and hemifacial spasm At rest: normal symmetry and tone Motion I slight to no movement of forehead J Ability to close eye with maximal effort and obvious asymmetry Ability to move corners of mouth with maximal effort and obvious asymmetry Patients with obvious but not disfiguring synkinesis, contracture, and d hemifacial spasm are grade 3 regardless of degree of motor activity
Evaluation of acute facial paralysis ◼ House-Brackman grade system ◼ III, moderate dysfunction: ◼ obvious but not disfiguring difference between two side ◼ No function impairment ◼ Noticeable but not severe synkinesis, contracture, and hemifacial spasm ◼ At rest: normal symmetry and tone ◼ Motion: ◼ slight to no movement of forehead ◼ Ability to close eye with maximal effort and obvious asymmetry ◼ Ability to move corners of mouth with maximal effort and obvious asymemetry ◼ Patients with obvious but not disfiguring synkinesis, contracture, and hemifcial spasm are grade 3 regardless of degree of motor activity
ENT Evaluation of acute facial paralysis House-Brackman grade system V, moderate severe dysfunction Obvious weakness and disfiguring asymmetry At rest: normal symmetry and tone motion no movement of forehead Inability to close eye completely with maximal effort u Asymmetrical movement of corners of mouth with maximal effort Patients with synkinesis, mass action, and hemifacial spasm severe enough to interfere with function are grade 4 regardless of degree of motor activity
Evaluation of acute facial paralysis ◼ House-Brackman grade system ◼ IV, moderate severe dysfunction: ◼ Obvious weakness and disfiguring asymmetry ◼ At rest: normal symmetry and tone ◼ motion: ◼ no movement of forehead ◼ Inability to close eye completely with maximal effort ◼ Asymmetrical movement of corners of mouth with maximal effort ◼ Patients with synkinesis, mass action, and hemifacial spasm severe enough to interfere with function are grade 4 regardless of degree of motor activity
ENT Evaluation of acute facial paralysis House-Brackman grade system a V, severe dysfunction Only barely perceptible motion At rest: possible asymmetry with droop of corner of mouth and decreased or absent nasolabial fold Motion: No movement of forehead Incomplete closure of eye Slight movement of corner of mouth Synkinesis, contracture, and hemifacial spasm usually absent V, total paralysis: no movement
Evaluation of acute facial paralysis ◼ House-Brackman grade system ◼ V, severe dysfunction: ◼ Only barely perceptible motion ◼ At rest: possible asymmetry with droop of corner of mouth and decreased or absent nasolabial fold ◼ Motion: ◼ No movement of forehead ◼ Incomplete closure of eye ◼ Slight movement of corner of mouth ◼ Synkinesis, contracture, and hemifacial spasm usually absent ◼ VI, total paralysis: no movement