1. Bells Palsy

2. Aetiology Most cases unknown Most likely cause is viral

3. Incidence Commonest in age group 10-40yrs 20 cases per 100,000 people

4. Examination Differentiate between upper and lower motor neurone lesion UML: frontalis is spared allowing normal furrowing of brow and eye blinking LML: all muscles of facial expression are affected

5. Examination continued Check no other cranial nerves involved (BP is an isolated VII lesion) Look for a painful rash over the ears (Ramsay Hunt caused by H zoster)

6. Red flags which may necessitate referral Bilateral BP Recurrent BP Association with rash elsewhere or with feeling generally unwell (sarcoid or Lyme disease) Previous episode which might have been demyelination ?SOL

7. Treatment Prednislone 1mg/kg up to 80mg max per day tailing off in second week (reduces oedema) Aciclovir 800mg 5x daily for 5days given within first 72hrs (prevents viral replication) Consider tape/eye pad so patient can sleep Consider prescription for artificial tears Reassure patient that he hasn’t had a CVA

8. Follow up 2/3rds of patients have spontaneous recovery 85% show improvement in the first 3/52 15% show some improvement in 3-6/12 Refer all cases to ENT after initiating Rx Consider referral to eye specialist for tarsorrhaphy for those patients who have failed to make a complete recovery