Bell’s Palsy
01) Synonyms of Bell’s Palsy :-
A) Antoni’s palsy
B) Facial nerve palsy
C) Facial paralysis
D) Idiopathic Facial Palsy.
E) Refrigeration Palsy.
02) Introduction of BellsPalsy :-
A) Bell’s Palsy or Bell’s palsy is Facial paralysis which is caused by dysfunction of cranial Nerve VII the facial Nerve.
B) Also known as Idiopathic Facial palsy. it named after sir “Charles Bell” who was a Scottish surgeon, neurologist and anatomist,
C) It results in inability or reduced ability, to move the muscles on the affected side of the face ie. Facial palsy.
D) Bell’s palsy is an idiopathic condition.ie no specific cause has been conclusively.
03)DEFINITION :-
The bell’s palsy is defined as a facial paralysis of acute onset attributed to acute non supportive inflammation of facial nerve within stylomastoid foramen. It may occur at any age from any infancy to old age, but appears to be most common in young adults, males are affected more then female.
04) CAUSE :-
The cause is after not clear. A type of herpes infection called herpes zoster is a painful, blistering skin rash due to the varicella – zoster virus , the virus that causes chicken pox might be involved. Other condition that may cause bill’s palsy include.
Traume – Basal skill fractures , facial injuries , penetrating injury to middle ear , altitude paralysis.
Infection – External otitis , otitis media &mastoiditis etc.
Metabolic – diabetes mellitus & hypertensions.
Neoplastic - Seventh Nerve tumor & Benign lesions of parotid.
Idiopathic – Familial bell palsy , Autoimmune syndrome & multiple sclerosis.
05)Pathophysiology :-
A) Bell’s palsy is the result of malfunction of the facial nerve (cranial nerve VII) , which controls the muscles of the face.
B) Facial palsy is typified by inability to move the muscles of facial expression.
C) The paralysis is of the infranuclear/ lower motor neuron type.
D) It is though that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skill within its bony canal.
E) Blocking the transmission of neural signals or damaging the nerve.
F) possible causes of facial paralysis include tumor, meningitis , stroke, diabetes mellitus , head trauma and inflammatory diseased of the cranial nerves.
06) SINGS AND SYMPTOMS –
a) A Cold is the starting before the symptoms of bell’s palsy begin.
b) symptoms are almost always on one side of the case only. They many range from mild to severe.
c) the face will feel stiff or pulled to one side and may look different.
d) difficulty in closing on eye.
e) difficulty in eating and drinking food. Falls out of one side of the mouth.
f) drooling due to lack of control over the muscles of the face.
g) Drooling of the face, such as the eyelid or corner of the mouth.
h) problem in smiling , or making facial expressions.
i) Twitching or weakness of the muscles in the face.
Other Symptoms :-
Dry eye which may lead to eye sores or infection.
Dry mouth.
Headache.
Loss of sense of taste.
Sound that is louder in one ear (hyperacusis)
Twitching in face.
07) DIAGNOSIS :-
a) Bell’s palsy can be diagnosed just by taking a health history and doing a complete physical examination.
b) If is doubtful that a brain tumor is causing your symptoms, you may need.
c) CT Scan of the head.
d) magnetic resonance imaging (MRI) of the head.
e) sometimes a test to check the nerves that supply the muscles of your face.
f) electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.
g) Nerve conduction test.
Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve.
08DIFFERENTIAL DIAGNOSES :-
The following condition also result in facial palsy –
Ramsay Hunt Syndrome – caused by herpes zoster infection.
Acoustic Neuroma – MRI Scan should be used to exclude this.
Facial schwannama – caused by a tumor of the facial nerve.
Neurological (Consider multiple sclerosis, and Guillain- Barre syndrome)
Infections , such as acute otitis media, cholesteatoma, viral infection including Epstein – barr virus.
Neoplasm, particularly parotid malignancy.
09) TREATMENT,:-
Medical
Physical Therapy.
Medical : -
Treatment of symptomatic patient with analysis may be necessary during the early stage if the ear is painful.
Corticosteroid – prednisone, are powerful anti-inflammatory agents.
If They can reduce the swelling of the facial nerve.
It will fit more comfortable within the bony corridor that surrounds it.
B Vitamin : - many of the B-Vitamin are assential for proper nervous system functioning.
Addition of a basic B- complex vitamin to the daily routine many be good idea during recovery. Some B’s that many be particularly beneficial are B1-B6-B12.
Physical Therapy :-
Short wave diathermy (SWD) : - used in early stage might be of benefit in bell’s palsy but there is little evidence to support the athermal theory and the efficacy of pulsed SWD.
Therefor the role of SWD in bell’s palsy might be controversial.
Also heating of facial muscles prior to exercise , massage or electrical stimulation can be attained by superficial heat therapy, which would have no effect on the inflamed nerve in bony canal.
Massage :-Effleurae, circular, finger & thumb kneading.
Which has frequently been prescribed for facial palsy, improve circulation and may prevent contracture.
Active exercise prevent muscle atrophy and improve muscle function.
3) Electrical stimulation :-
Two way –
A – put a one electron on the nerve, and the second electron on any muscle stimulation want.
B- Electron put on muscle unaffected muscle, second electron on the affected muscle.
Aims at preserving muscle bulk especially in complete paralysis and it has psychological benefit as the patient observes muscle contraction in his face that gives him for recovery from facial paralysis.
4) Therapeutic heat and cold –
Heat – Improve local circulation and dower skin resistance to electrical stimulation.
Cold - ICE stimulation has to be preformed to a specific muscle group, to increase the muscles contraction power.
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