Etiology The precise etiology of BP is unknown and its diagnosis is on the basis of exclusion. Consequently, it is essential to eliminate all other potential etiologies of facial paralysis and paresis before diagnosing BP. Currently, there are numerous theories regarding the cause of BP. Compression of the facial nerve due to inflammation or edema along its narrow intra-bony path may cause facial nerve abnormalities. Viral infection is hypothesized to be another etiological factor. Various studies have demonstrated the presence of HSV-1 DNA in the endoneural fluid of the facial nerve in BP patients, as well as the ability of HSV-1 to cause facial paralysis in animal models. Currently, the HSV-1 mediated inflammation of the facial nerve in the narrow fallopian canal is widely accepted to be the mechanism responsible for the majority of BP cases. Furthermore, acute ischemia due to vasospasms, as well as inflammation-induced demyelination of the facial nerve have been proposed as possible etiological factors. abnormalities (excluding hyperacusis), other systemic involvement, history of cancer, prior insect bite, and rash in or around the ear. The rate of misdiagnosis of BP has been demonstrated to be approximately 10.8%. Treatment While most cases of BP (85%) resolve spontaneously within 3 weeks, it is important to avoid complications and minimize the risk of incomplete recovery. Seventy percent of patients regain full function within 6 to 9 months. Ophthalmic side effects such as incomplete eye closure and infrequent blinking are common, which can lead to keratitis, infection, corneal ulceration, and blindness if left untreated. It is crucial for patients to regularly use eye drops throughout the day and ointments at night, and wear eye shields. Management of BP includes the use of corticosteroids— due to their anti-inflammatory properties—within the first 72 hours of the onset of symptoms. Clinical practice guidelines recommend 50 mg of Prednisolone for 10 days or 60 mg of Prednisone for 5 days followed by a 5-day tapered dose. Another pharmacological modality is the use of anti-viral medications, due to the possible viral etiology of the condition. While no added benefit is observed when adding antivirals and corticosteroids together in the management of BP, this combination may potentially lead to decreased complications such as crocodile tears and motor synkinesis. Currently, anti-viral medications acyclovir (400 mg 5 times a day for 5 days), and valacyclovir (1000 mg a day for 5 days) are indicated if the facial palsy is due to herpes zoster oticus, indicating Ramsay-Hunt syndrome. Surgical decompression has also been suggested as a modality and is indicated when routine management modalities are not responsive. Dental Implications The development of BP following dental procedures has been classified into 2 categories: immediate-onset and delayed-onset BP. Immediate-onset BP has a rapid recovery and involves local anesthetic complications, hematoma formation, and trauma afflicted by procedures. Vasoconstrictor agents in local anesthetics and their possible neurotoxic properties have been associated with BP. The current evidence suggests procaine and tetracaine are more harmful than bupivacaine and lidocaine. Furthermore, a blast of air into the extraction Management Diagnosis Thorough clinical examinations and medical history are essential indiagnosingBP. CT scans,MRI, serologicalworkups, electroneurography (ENG), and electromyography (EMG) can be utilized in the diagnosis of BP. The history should enquire about the onset of the facial palsy, as a progressive and slow occurring facial palsy is indicative of a neoplastic or infective etiology. Alternative pathologies including neurologic, otologic, trauma, inflammatory, and congenital abnormalities should also be excluded. Various signs and symptoms could prompt the clinician to consider an alternative diagnosis. These signs and symptoms include severe pain, hearing or vestibular Various signs and symptoms could prompt the clinician to consider an alternative diagnosis. These include severe pain, hearing or vestibular abnormalities (excluding hyperacusis), other systemic involvement, history of cancer, prior insect bite, and rash in or around the ear. CONTINUEDP. 34 33 Issue 6 | 2022 | SupportingYour Practice
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