Po1538 Case Report: Bell´s Palsy

Elsa Costa1, Diogo Durais1 e Joana Oliveira2
1USF Monte Crasto; 2Gondomar
Male patient, 56 years of age, personal history of arterial hypertension diagnosed 2 years ago, controlled with medication. Resorted to consulting family medicine, at 20 November 2013, by the appearance of facial asymmetry occurs overnight. No apparent triggering factors. Without prodromes (headache, earache or hearing loss). Physical examination: afebrile, facial asymmetry, changes of left hemiface (decreased movements of the forehead, ptosis with dry eye, facial weakness and deviation of the labial commissure). Erasing nasolabial folds. No change in taste or salivation. Without hyperacusis or synkinesis. Normal otoscopy. Remaining normal neurological examination. Diagnosed with idiopathic unilateral facial nerve paralysis. Indication for measures general application of artificial tears and ocular lubricant gel, ocular occlusive dressing, medicated with and prednisone 80mg/day during 10 days and physiotherapy treatments. Peripheral facial paralysis (PFP) is a common condition. Incidence 20/100000 (peak 15-40y), no racial predilection, geographical or gender. Increased risk during pregnancy and diabetes. There are multiple causes: congenital , traumatic , neoplastic , infectious , metabolic , toxic and iatrogenic . The most common is Bell´s palsy (idiopathic). In adults is related to activation of the herpes simplex virus and Bell’s palsy. The location of the injury to the facial nerve path level leads different clinical presentations. Generally are not necessary diagnostic procedures. For treatment is consensual the use of corticosteroids. There is no significant benefit from the use of antiviral isolated compared to placebo. There seems to be benefit of the combination of antiviral ( acyclovir or valaciclovir ) with prednisone in severe cases of PFP . Physical therapies are used to speed recovery and minimize sequelae. Complete recovery is found in about 90 %. The recurrence rate is less than 10%. The prognosis is favourable and is related to the aetiology and severity of the injury. For its the assessment the House- Brackman´scale and electrophysiological test can be used. In the future new techniques may eventually decrease the % of idiopathic cases.
facial nerve disease