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Facial nerve and its disorders

Question
25 out of 33
 

Bell's palsy patient comes on day 3. Treatment given would be: [AIIMs Nov 09, May 20 1 0]



A Intratympanic steroids

B Oral steroids + vitamin B

C Oral steroids + Acyclovir

D Vitamin B Vasodilator

Ans. C Oral steroids + Acyclovir

I. Steroid therapy:

a. Oral prednisolone has been used extensively to treat patients with Bells palsy.

b. Proof of efficacy is however controversial.

c. Steroids are considered useful because they have an anti inflammatory response.

d. Because the cost of therapy is less and it has low risk of side effects, predinosolone is commonly started at the initial visit

e. Initiation of therapy during the first 24 hours of symptom confers a higher likelihood of recovery

II. Antiviral therapy:

a. It represents a newer adjunct in treating acute facial palsy of viral origin (Both Bells palsy and ~amsay hunt syndrome)

b. Oral acyclovir is the DOC

c. Some studies have shown that patients who receive prednisolone plus oral acyclovir have a higher recovery rate and reduced rates

d. of synkinesis in comparison to those who receive prednisolone alone.

e. Based on above evidence most surgeons advocate combination of steroids and antiviral drugs.

The usual recommended regime is predisolone 1 mg/kg/day for five days followed by a ten day taper and oral acyclovir (200-400 mg 5 times daily) for ten days.

Physical Management

Includes:

Electrical stimulation: It is done to maintain membrane conductivity and reduce muscle atrophy

It is generally used in patients left with partial defects

Eye care: The cornea is vulnerable to drying and foreign body irritation in acute facial palsy due to orbicularis oculi dysfunction.

So measures conferring corneal protection are recommended. Like:

a. Artificial tears drops at daytime

b. Ocular ointment at night

c. Use of sunglasses etc

In long standing cases: Reducing the area of exposed cornea by implanting a gold weight in the upper lid (tarsorapphy) is done.

Surgical Management

Nerve decompression

a. Principle used behind it - Axonal ischemia can be reduced by the decompression of nerve segments presumed to be inflammed and entrapped. .

b. Decompression of the facial nerve is done in cases who have a poor prognosis for complete recovery with medical treatment alone.

Facial nerve and its disorders Flashcard List

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