Features

• Rapid onset hours to days of unilateral facial paralysis involving both upper and lower face

• Lag in eyelid closure is almost always present in BP and also never in stroke

• Drooping of the corner of the mouth

• Flattening of nasolabial fold

• Subjective numbness or tingling

• Retro-auricular pain 24 to 72 hours prior

• Severe cases is loss of taste, intolerance of high-pitched sounds

• May have dysarthria with eating

Exam:

• Ensure upper and lower facial muscles involved

• If billateral, suspect sarcoid, GBS, MG, myopathy

• CN exam, especially CN6+7

• Limb strength

• ENT for Ramsay Hunt, parotid gland, lymphadenopathy

Treatment:

• Pred 1mg/kg up to 75mg for 5 days

• If severe, or signs Ramsay Hunt add antiviral

• Eye protection if can’t close eye

• Review at 2 and 6 weeks

• If worsening or no improvement at 6 weeks refer to Neurology

• If no recovery at 3 months exclude tumour of temporal bone or parotid

Reference:

• Facial Palsy - HNE Pathways