Gå direkt till huvudinnehållet

Facialispares

Senast uppdaterad: Senast reviderad:


Definition:
Ansiktsförlamning beroende på en perifer eller central skada på nerven. En specialvariant med okänd orsak kallas Bells pares.
Förekomst:
Incidens är 15–30 fall per 100 000 individer och år.
Symtom:
Svårighet att sluta ögat, äta och tala. Kosmetiska problem tillkommer samt nedsatt livskvalitet. Insjuknandet är akut, oftast två till fyra dagar till maximal muskelsvaghet (ibland upp till sju dagar).
Kliniska fynd:
Perifer facialispares ger svaghet i pannans, ögats, näsans och munnens mimiska muskulatur på drabbad sida. Central facialispares ger svaghet i ansiktets ena halva förutom en normal rörlighet i pannan på drabbad sida. Paresens svårighetsgrad kan bedömas och följas med Sunnybrook-skalan .
Diagnos:
Typisk klinisk bild. Lumbalpunktion vid misstanke om neuroborrelios. CT/MR hjärna vid central pares.
Behandling:
Ögonskydd och prednisolon vi Bells pares. Antibiotika vid borrelios. Antivirusbehandling vid herpes zoster. 
  1. Tiemstra JD, Khatkhate N. Bell's palsy: diagnosis and management. Am Fam Physician 2007; 76: 997-1002. PubMed  
  2. Royal W 3rd, Vargas D. Bell's palsy and vestibular neuronitis. Handb Clin Neurol. 2014;123:763-70. doi: 10.1016/B978-0-444-53488-0.00037-7.
  3. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; 549: 4-30. PubMed  
  4. Katusic SK, Beard CM, Wiederholt WC, Bergstralh EJ, Kurland LT. Incidence, clinical features, and prognosis in Bell's palsy, Rochester, Minnesota 1968-1982. Ann Neurol 1986; 20: 622-7. PubMed  
  5. Podvinec M. Facial nerve disorders: anatomical, histological and clinical aspects. Adv Otorhinolaryngol 1984; 32: 124-93. PubMed  
  6. Holland NJ, Weiner GM. Recent developments in Bell's palsy. BMJ 2004; 329: 553-7. PubMed  
  7. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell's palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 1996; 124: 27-30. Annals of Internal Medicine  
  8. Linder T, Bossart W, Bodmer D. Bell's palsy and herpes simplex virus: fact or mystery? Otol Neurotol 2005; 26:109-13. PubMed  
  9. Stjernquist-Desatnik A, Skoog E, Aurelius E. Detection of herpes simplex and varicella-zoster viruses in patients with Bell's palsy by the polymerase chain reaction technique. Ann Otol Rhinol Laryngol 2006; 115: 306-11. PubMed  
  10. Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91 –102. PMID: 17522387. PubMed  
  11. Mutsch M, Zhou W, Rhodes P, Bopp M, Chen RT, Linder T, et al. Use of the inactivated intranasal influenza vaccine and the risk of Bell's palsy in Switzerland. N Engl J Med 2004; 350: 896-903. New England Journal of Medicine  
  12. Peng K-P, Chen Y-T, Fuh J-L, et al. Increased riskof Bell pasly in patients with migraine. Neurology 2014. doi: 10.1212/WNL.0000000000001124 DOI  
  13. Stanek G, Strle F. Lyme borreliosis. Lancet 2003; 362: 1639-47. PubMed  
  14. Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatr 2001; 71: 149. PubMed  
  15. Adour K, Wingerd J, Doty HE. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell's palsy). Diabetes 1975; 24: 449-51. PubMed  
  16. Hultcrantz M. Rehabilitation of Bells' palsy from a multi-team perspective. Acta Otolaryngol. 2016;136(4):363-7. PMID: 26634395 PubMed  
  17. Salinas RA, Alvarez G, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews, issue 1, 2009. The Cochrane Library  
  18. Engström M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008; 7: 993-1000. PubMed  
  19. Bremell D, Hagberg L. Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy). BMC Infect Dis 2011; 11: 215.
  20. Marsk E, Hammarstedt L, Berg T et al. Early Deterioration in Bell's Palsy: Prognosis and Effect of Prednisolone. Otol Neurotol. 2010 Dec;31(9):1503-7. PMID: 20818286 PubMed  
  21. 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. PMID: 31486071 PubMed  
  22. Grogan PM, Gronseth GS. Practice parameter: steroids, acyclovir, and surgery for Bell's palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56: 830-6. Neurology  
  23. Ramsey MJ, DerSimonian R, Holtel MR, Burgess LP. Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis. Laryngoscope 2000; 110: 335-41. PubMed  
  24. Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016 Jul 18;7:CD001942 . pmid: 27428352 PubMed  
  25. Wood MJ, Shukla S, FIddian AP, Crooks RJ. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis 1998; 178 (Suppl 1): S81-S84.
  26. Berg T, Stjernquist-Desatnik A, Kanerva M, Hultcrantz M et al. Bells pares ger resttillstånd hos 30 procent av vuxna patienter. Läkartidningen. 2015;112:C6RD. www.lakartidningen.se  
  27. Chen N, Zhou M, He L, et al. Acupuncture for Bell’s palsy. Cochrane Database Syst Rev. 2010;CD002914. PMID: 20687071. PubMed  
  28. Bulstrode NW, Harrison DH. The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry. Plast Reconstr Surg 2005; 115: 1466-71. PubMed  
  29. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell`s palsy. N Engl J Med 2007; 357: 1598-607. New England Journal of Medicine  
  30. Marsk E, Bylund N, Jonsson L et al. Prediction of nonrecovery in Bell's palsy using Sunnybrook grading. Laryngoscope. 2012 Apr;122(4):901-6. PMID: 22374870 PubMed  
  31. Bylund N, Jensson D, Enghag S et al. Synkinesis in Bell's palsy in a randomised controlled trial. Clin Otolaryngol. 2017 Jun;42(3):673-680. PMID: 27882653 PubMed  
  32. Yoo MC, Soh Y, Chon J, et al. Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy published online ahead of print, 2020 Jan 23. JAMA Otolaryngol Head Neck Surg. 2020;10.1001/jamaoto.2019.4312. PMID: 31971554 PubMed  
  33. Ronthal M. Bell's palsy: Treatment and prognosis in adults. UpToDate, last updated Nov 30, 2018. UpToDate  
  34. Gilden DH. Clinical practice. Bell's palsy. N Engl J Med 2004; 351: 1323-31. New England Journal of Medicine  
  35. Morris AM, Deeks SL, Hill MD, Midroni G, Goldstein WC, Mazzulli T, et al. Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy. Neuroepidemiology 2002; 21: 255-61. PubMed  
  • Malou Hultcrantz, professor och specialist i ÖNH-sjukdomar, Karolinska institutet
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet