Резюме
Определение
History and exam
Key diagnostic factors
- episódio único
- unilateral
- ausência de sintomas constitucionais
- envolvimento de todos os ramos do nervo
- ceratoconjuntivite seca
- dor
- sincinesia
Other diagnostic factors
- presença de fatores de risco
- qualquer idade
- hiperacusia
- disgeusia
Risk factors
- vacinação intranasal contra a gripe (influenza)
- gestação
- infecção do trato respiratório superior
- clima árido/frio
- hipertensão
- história familiar de paralisia de Bell
- diabetes
- procedimentos odontológicos
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
- eletroneuronografia (ENoG) (eletromiografia evocada – eEMG)
- eletromiografia com agulha
- Sorologia para Borrelia burgdorferi
Investigations to consider
- audiometria de tons puros
- timpanometria e reflexo estapediano
- ressonância nuclear magnética (corte fino com realce de gadolínio do curso do nervo facial)
- tomografia computadorizada (corte fino, sem contraste)
Treatment algorithm
todos os pacientes
Contributors
Authors
Matthew Q. Miller, MD
Assistant Professor Otolaryngology-Head and Neck Surgery
Director UNC Facial Nerve Center
University of North Carolina-Chapel Hill
Chapel Hill
NC
Disclosures
MQM is a paid consultant for Checkpoint Surgical, Inc.
Liliana Ein, MD
Assistant Professor Otolaryngology-Head and Neck Surgery
Division of Facial Plastic and Reconstructive Surgery
University of Miami
Miami
FL
Disclosures
LE declares that she has no competing interests.
Acknowledgements
Dr Matthew Q. Miller and Dr Liliana Ein would like to gratefully acknowledge Dr Tessa Hadlock, Dr Nathan Jowett, Dr Vishnu Madhok, Dr Iain Swan, Dr Pauline Lockhart, Dr Michael Norbury, and Dr John Gail Neely, previous contributors to this topic.
Disclosures
TH, VM, IS, PL, MN, and JGN declare that they have no competing interests. NJ holds a patent on the methods and systems for functional electrical stimulation of the paralysed face (WO2017124019A1).
Peer reviewers
Giles Elrington, MBBS (Hons), MD, FRCP
Consultant Neurologist
Barts Health NHS Trust
London
UK
Disclosures
GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences and symposia with the following companies - GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, and BMJ.
Patrick Grogan, MD
Major
US Air Force
MC Program Director
Department of Neurology
MMCN
Wilford Hall Medical Center
Lackland Air Force Base
TX
Disclosures
PG declares that he has no competing interests.
Venkat Srinivasan, MBBS, DLO, FRCS (Ed), FRCS (ORL)
Consultant in ENT/Thyroid Surgery
Arrowe Park Hospital
Upton
Wirral
UK
Disclosures
VS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy. Neurology. 2012 (reaffirmed 2023) Nov 27;79(22):2209-13.Full text Abstract
Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;(7):CD001942.Full text Abstract
Gagyor I, Madhok VB, Daly F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019 Sep 5;9:CD001869.Full text Abstract
Gantz BJ, Rubinstein JT, Gidley P, et al. Surgical management of Bell palsy. Laryngoscope. 1999 Aug;109(8):1177-88. Abstract
Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Herpes-zóster ótica (síndrome de Ramsay Hunt)
- Doença de Lyme
- Tumor benigno do nervo facial (por exemplo, schwannoma do nervo facial)
More DifferentialsGuidelines
- ACR appropriateness criteria: cranial neuropathy
- Management of acute Bell's palsy
More GuidelinesPatient information
Paralisia de Bell
More Patient information
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