Background
- Idiopathic unilateral facial nerve palsy (not sparing forehead)
- Suspected etiologies include HSV-1 or other viral infection
Differential Diagnosis
- Ramsay Hunt syndrome (VZV)
- Lyme disease (may be bilateral, with or without meningitis)
- Complication of otitis media, mastoiditis, or cholesteatoma
- Guillain-Barré syndrome
- HIV, with or without opportunistic infection
- Sarcoidosis
- Sjögren syndrome
- Tumour
- Stroke, typically sparing the forehead and eyelid muscles
Management
- Corticosteroids (NNT 50 for mild-to-moderate, 8 for severe)
- No role for antivirals alone, but can consider adding in cases of severe Bell palsy
Further Reading
- de Almeida JR, et al. Management of Bell palsy: clinical practice guideline. CMAJ. 2014;186(12)917-922.
