Assessment and management of facial nerve palsy

Masterson, Liam; Vallis, M. P.; Quinlivan, R.; Prinsley, Peter

doi:10.1136/bmj.h3725

Cited by 33 publications

(23 citation statements)

References 19 publications

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“…Lyme disease carries significant morbidity, including the potential to develop facial palsy, a potentially devastating condition. 6 Although there are areas of the country where Lyme disease is thought to be endemic, 7 there is limited knowledge about who gets it, where, and when. 2 Awareness of high-risk areas in the UK would allow appropriate preventive and treatment strategies to try to target Lyme disease and associated facial palsy.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that approximately 10% of patients with Lyme disease develop facial palsy. 6 The authors found that only 3.5% of patients with Lyme disease developed an associated facial palsy from 2011 to 2015, which is less than expected but many more than were seen in the general population. It is possible that some facial palsy diagnoses were not coded if a cause such as Lyme disease was identified, because Bell's palsy by definition is idiopathic (but there is no separate code for facial palsy).…”

Section: How This Fits Inmentioning

confidence: 91%

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Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

Cooper

Branagan-Harris²,

Tuson³

et al. 2017

Br J Gen Pract

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Section: Discussionmentioning

confidence: 99%

Section: How This Fits Inmentioning

confidence: 91%

Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

Cooper

Branagan-Harris²,

Tuson³

et al. 2017

Br J Gen Pract

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“…As it was an established fact that some tick species are capable of producing paralytic toxins [ 8 ], we attributed tick toxicosis and paralysis to explain the emerging problem of 7th cranial nerve palsy. Thus patients were managed as if other cases of facial palsy [ 9 ], but recovery was slow and some patients took years. However, considering the sporadic nature of the cases of facial palsy despite high incidence of otoacariasis, we thought about other possible aetio-pathological conditions by about 2011.…”

Section: Introductionmentioning

confidence: 99%

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

et al. 2018

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BackgroundOver the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem.MethodsAll cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified.ResultsThere were 29 patients with mean age of 46 years (range 22–76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1–55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species.ConclusionsOn contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.

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“…This is because the diagnosis is not one of exclusion—despite this being commonly how it is described,6 as a lower motor neurone facial weakness where all alternative causes have been eliminated—but rather it is a positive recognition of a clinical syndrome, with several exclusions described below. It would perhaps be more accurately referred to as ‘Bell's palsy syndrome’ 7.…”

Section: What Is In a Name?mentioning

confidence: 99%

Bell's palsy syndrome: mimics and chameleons

Fuller

Morgan

2016

Pract Neurol

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In this article we will explore the mimics and chameleons of Bell's palsy and in addition argue that we should use the term 'Bell's palsy syndrome' to help guide clinical reasoning when thinking about patients with facial weakness. The diagnosis of Bell's palsy can usually be made on clinical grounds without the need for further investigations. This is because the diagnosis is not one of exclusion (despite this being commonly how it is described), a lower motor neurone facial weakness where all alternative causes have been eliminated, but rather a positive recognition of a clinical syndrome, with a number of exclusions, which are described below. This perhaps would be more accurately referred to a 'Bell's palsy syndrome'. Treatment with corticosteroids improves outcome; adding an antiviral probably reduces the rates of long-term complications.

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Assessment and management of facial nerve palsy

Cited by 33 publications

References 19 publications

Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Bell's palsy syndrome: mimics and chameleons

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