Warning

History

  • Acute lower motor neurone (involving whole face) facial palsy
  • May be preceded by 1-2 day history of mild facial/ear pain
  • Ask about ear symptoms – more severe pain may suggest Ramsay Hunt Syndrome (look for vesicles in ear), if any associated reduced hearing/ear discharge d/w ENT same day

Examination

  • Assess/document facial movement – eye closure/forehead movement, can use House Brackman Scale (see below)
  • Examine ear – any features of infection or cholesteatoma then d/w ENT same day
  • Examine parotid, oropharynx (for deep parotid lobe involvement) and remaining cranial nerves – any abnormalities refer to ENT as Urgent Suspected Cancer

Management - based on Scottish Bells Palsy Study

  • Treat with oral Prednisilone 25mg X2/day for 10 days
  • If any suggestion of Ramsay Hunt Syndrome oral Acyclovir 400mg X5/day for 7 days
  • If unable to close eye easily
    • Tape eye closed  at night
    • Lacrilube to eye at night
    • Hypromellose 2-3 eye drops X3/day

Follow up

With Primary Care if not complete resolution in 4 weeks

House Brackman Scale

Editorial Information

Last reviewed: 15/06/2023

Next review date: 15/06/2026

Author(s): Carr E.

Version: V1

Author email(s): Esmond.carr@borders.scot.nhs.uk .

Approved By: McCarthy C

Reviewer name(s): Carr E.