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上海交通大学医学院
教
案
第
课程名称：Idiopathic Facial Palsy (Bell Palsy)
肖勤
教师姓名
职称
副主任
教研室
2007 年
神经病学
9月
教学时数
21 日
0.5
授课题目
Idiopathic Facial Palsy (Bell Palsy)
教学对象
临床医学系 04 级英文班
授课地点
瑞金科教大厦 309 室
教学方式
课堂
本课的重点、难点：
1.
2.
3.
4.
5.
6.
7.
8.
次课
Anatomy of facial nerve
Clinical manifestations of facial palsy
Bell phenomenon
Ramsey Hunt syndrome
Difference between peripheral and central facial palsy
Diagnosis of facial palsy
Differential diagnosis of facial palsy
Treatment of facial palsy
本次课应用的教具：
POWERPOINT
1． 主要教学内容：
（可另附页）
Anatomy
Pathophysiology
•Bell palsy is thought to be caused by edema and ischemia resulting in compression of the facial
nerve in its course through the bony canal.
In the past, cold exposure were considered the only triggers. However, most authors now believe
that the herpes simplex virus (HSV) is the most likely cause.
Epidemiology
Clinical manifestations
•Symptoms:
–Acute onset of unilateral upper and lower facial paralysis.
The paralysis must include the forehead and lower aspect of the face.
- inability to close the eye or to smile on the affected side.
- increased saliva on the side of the paralysis.
If the paralysis involves only the lower portion of the face, a central cause should
be suspected.
–Posterior auricular pain
–Decreased or increased tearing
–Hyperacusis
–Taste disturbances
Physical Examination:
•flattening of the forehead and nasolabial fold on the affected side.
•When the patient is asked to raise the eyebrows, the affected side will remain flat.
•When the patient is asked to smile, the face becomes distorted and lateralizes to the side
opposite the palsy.
•The patient is not able to close the eye completely on the affected side. On attempted eye
closure, the eye rolls upward and inward on the affected side. This is known as Bell
phenomenon.
Ramsey Hunt syndrome
•Ramsey Hunt syndrome is similar to Bell‘s palsy. The virus that causes the syndrome has been
identified as varicella zoster virus (VZV), a strain of the Herpes virus.
•In addition to the "classic" symptoms of Bells palsy, Hunt syndrome is associated with some
additional symptoms that help differentiate it.
1. pain: often in or behind the ear. 2.vertigo: 3. hearing loss: can also affect the auditory
nerve, resulting in hearing deficit. This should not occur with Bells palsy. 4. blisters in the ear
5. Swollen and tender lymph nodes near the affected area
Differential Diagnosis
Guillain-Barre syndrome
Meningitis
middle ear or mastoid infections
cerebellopontine angle tumors
Work-up
nerve conduction testing and EMG
Treatment
•The most widely accepted treatment is corticosteroids.
•Since HSV is widely accepted as the likely etiologic agent, acyclovir has also been used. The
dose of acyclovir is 400 mg orally 5 times per day.
•VitB1、VitB12
Eye care:
•Facial muscle exercises
本
次
课
小
结
要
点
Anatomy
Pathophysiology
Bell palsy is thought to be caused by edema and ischemia resulting in compression of the
facial nerve in its course through the bony canal. cold exposure and herpes simplex virus
were considered as the triggers.
Epidemiology
Clinical manifestations
Symptoms:Acute onset of unilateral upper and lower facial paralysis. The paralysis must
include the forehead and lower aspect of the face. If the paralysis involves only the lower
portion of the face, a central cause should be suspected. Posterior auricular pain, Decreased
or increased tearing, Hyperacusis, and Taste disturbances
Physical Examination:
•flattening of the forehead and nasolabial fold on the affected side. When the patient is
asked to raise the eyebrows, the affected side will remain flat. When the patient is asked to
smile, the face becomes distorted and lateralizes to the side opposite the palsy.
•The patient is not able to close the eye completely on the affected side. On attempted eye
closure, the eye rolls upward and inward on the affected side. This is known as Bell
phenomenon.
Ramsey Hunt syndrome
•Ramsey Hunt syndrome is similar to Bell‘s palsy. The virus that causes the syndrome has
been identified as varicella zoster virus (VZV), a strain of the Herpes virus.
•In addition to the "classic" symptoms of Bells palsy, Hunt syndrome is associated with
some additional symptoms that help differentiate it.
pain: often in or behind the ear,vertigo: hearing loss(This should not occur with Bells
palsy), blisters in the ear,Swollen and tender lymph nodes near the affected area
Differential Diagnosis: Guillain-Barre syndrome, Meningitis, middle ear or mastoid
infections, cerebellopontine angle tumors
Work-up
nerve conduction testing and EMG
•Treatment: corticosteroids, acyclovir, VitB1 、 VitB12, Eye care, Facial muscle
exercises.
本
次
课
复
习
思
考
题
下
次
课
预
习
要
点
1.
2.
3.
4.
5.
6.
7.
8.
Anatomy of facial nerve
Clinical manifestations of Bell palsy
Ramsey Hunt syndrome
Diagnosis of Bell palsy
Differential Diagnosis of Bell palsy
Treatment of Bell palsy
Difference between peripheral and central facial palsy.
Bell phenomenon.