Nelissen Rik C, Honings Jimmie, Meijer Frederick J A, Kunst H P M, Ingels Koen J A O
Radboudumc, afd. Keel-Neus-Oorheelkunde en Heelkunde van het Hoofd-Halsgebied, Nijmegen.
Contact: R.C. Nelissen (
Ned Tijdschr Geneeskd. 2019 Jan 24;163:D2594.
Patients with facial palsy present with both cosmetic and functional symptoms. When a facial palsy develops quickly (within 72 hours) with no other symptoms, and no cause can be identified, it is probably an idiopathic facial palsy or 'Bell's palsy'. The diagnosis Bell's palsy is, thus, to a certain extent a diagnosis 'per exclusionem'. We present three cases with an incorrectly diagnosed Bell's palsy or inadequate diagnostics or treatment: a 5-year-old male with recurrent facial palsy caused by acute otitis media; a 46-year-old male with facial palsy caused by a malignant parotid tumour; and a 75-year-old female with facial palsy caused by a facial nerve schwannoma in the mastoid segment of the facial nerve. We, therefore, emphasize the importance of thorough history-taking and adequate diagnostics and imaging when patients present with facial palsy.
面瘫患者会出现外观和功能方面的症状。当面瘫迅速发展(72小时内)且无其他症状,又无法确定病因时,可能是特发性面瘫或“贝尔氏面瘫”。因此,贝尔氏面瘫的诊断在一定程度上是一种“排除性诊断”。我们呈现三例贝尔氏面瘫诊断错误、诊断不充分或治疗不当的病例:一名5岁男性因急性中耳炎导致复发性面瘫;一名46岁男性因腮腺恶性肿瘤导致面瘫;一名75岁女性因面神经乳突段神经鞘瘤导致面瘫。因此,我们强调当患者出现面瘫时,详细病史采集、充分诊断及影像学检查的重要性。