Bell Paralizi
Özet
Bell paralizisi (BP), yedinci kraniyal sinirin (fasiyal sinir) genikulat ganglionda sıkışması ve iltihaplanması sonucu gelişen, ani başlangıçlı ve tek taraflı periferik yüz felcinin en sık nedenidir. Kesin etiyolojisi bilinmemekle birlikte, HSV-1 ve VZV gibi virüslerin reaktivasyonu, vasküler iskemi veya otoimmün mekanizmalar patogenezde suçlanmaktadır. Klinik olarak hastalar, 72 saat içinde zirveye ulaşan alın kasları dahil yüzün yarısında kısmi ya da tam güçsüzlük, göz kapayamama, tat bozukluğu ve kulak ağrısı gibi semptomlarla başvururlar. Tanı esas olarak fizik muayene ve Taverner kriterlerine göre konulurken; derecelendirmede House-Brackmann Skalası, prognoz tayininde ise ENG ve EMG testleri kullanılır. Tedavinin temel amacı korneayı korumak ve iyileşmeyi hızlandırmak olup, ilk 72 saatte oral kortikosteroidler altın standarttır; ağır vakalarda tedaviye antiviraller eklenebilir, ancak cerrahi dekompresyon rutin olarak önerilmemektedir. Çoğu hastada kendiliğinden tam iyileşme görülse de, %25'e yakınında sinkinezi, kontraktür ve yüz asimetrisi gibi kalıcı sekeller gelişebilir.
Bell's palsy (BP) is the most common cause of acute, unilateral peripheral facial paralysis, resulting from the compression and inflammation of the seventh cranial nerve (facial nerve) within the geniculate ganglion. Although its exact etiology remains unknown, reactivation of latent viruses such as HSV-1 and VZV, vascular ischemia, or autoimmune mechanisms are implicated in its pathogenesis. Clinically, patients present with partial or complete weakness on one side of the face involving the forehead muscles, which peaks within 72 hours, alongside inability to close the eyelid, taste disturbances, and otalgia. Diagnosis is primarily clinical based on physical examination and Taverner criteria, while the House-Brackmann Scale is utilized for grading severity, and ENG/EMG are employed for prognosis determination. The primary goals of management are corneal protection and accelerating recovery; oral corticosteroids constitute the gold standard within the first 72 hours, and antivirals may be added in severe cases, whereas surgical decompression is not routinely recommended. Although most patients recover spontaneously, approximately 25% may suffer from long-term sequelae including synkinesis, contractures, and persistent facial asymmetry.
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