Familial idiopathic facial palsy

The Epidemiology and Management of Bell's Palsy in the Sudan

Background:

Bell’s palsy is an acute idiopathic facial nerve paralysis of sudden onset. It is the most common cause of lower motor neuron facial nerve paralysis with an annual incidence of 15-30 per 100,000.

The objective of this work is to study the prevalence and the management of Bell’s palsy in the Sudan. A descreptive retrospective cross-sectional study was carried at Khartoum Teaching Dental Hospital, Khartoum General Teaching Hospital.

In the retrospective, the records and files of 698 patients with Bell’s palsy, were reviewed in relation to age, gender, site, risk factors, season, and type of treatment.

In addition, 48 patients with Bell’s palsy were evaluated using the House–Brackman scale in relation to the above-mentioned variables.

Therefore, a total number of 746 cases were studied. Fifty five percent of them were females and the remaining 45% were males, around 38% of them were in the age group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of onset where 53.5% of the cases occurred. Steroids are the commonly prescribed drugs in majority of the cases, accounting for 47.3%.

Study Design:

The study is a retrospective cross sectional hospital based study. The study was carried out in Khartoum Teaching Dental Hospital and in the Physiotherapy Department of Khartoum Teaching General hospital.

The files and records of the patients with Bell’s palsy in Khartoum Teaching Dental Hospital in the years 1/1/2004 -31/12/2008, and Khartoum Teaching General Hospital (physiotherapy department) in the years 2007- July 2009 (total number 746).

Results:

A total number of 746 cases were studied . Fifty five percent of them were females and the remaining 45% were male. Around 38% of them were in the group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of the onset where 53.5% of the cases occurred.

Conclusion:

The study showed predominance of females. A peak incidence was seen in the age group 21-40 years. A predilection was found for the right side of face.

Considerations and complications after Bells' palsy

We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications.

Familial Bell's Palsy: A Case Report and Literature Review

Objective. To describe a unique case of familial Bell's palsy and summarize the current literature regarding possible hereditary influences. Design. Case report. Main Outcome Measures. Clinical exam, CSF analysis, and family history provided per the patient. Results. We report the case of a 58-year-old female who presented with recurrent and bilateral episodes of facial palsy. The patient underwent multiple CSF investigations to rule out a possible infectious and rheumatologic etiology that were all negative. Further questioning revealed she was one of seven family members with a history of unilateral facial nerve paralysis. Conclusion. The sheer number of similar case studies to date suggests that familial clustering of Bell's palsy is a real, noncoincidental phenomenon. Our case represents a unique and perplexing example of one such family. Familial Bell's palsy may represent an autoimmune disease secondary to inherited HLA alloantigens or a structural predisposition to disease based on the dimensions of the facial canal.

Differential diagnosis of recurrent or bilateral peripheral facial palsy

Objective:

To describe the differential diagnosis of recurrent or bilateral peripheral facial palsy.

Method:

Case report and literature review.

Results:

Two patients with recurrent, alternating, peripheral facial palsy are described. In both patients, additional investigation was performed to search for a specific diagnosis. In the first patient, only a positive family history was found, indicating a possible familial susceptibility. In the other patient, diabetes mellitus and hypertension were identified as risk factors.

Conclusion:

There is an important and extensive differential diagnosis of recurrent or bilateral facial palsy. However, in a large proportion of patients the cause remains unknown.