BELLS PALSY

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DEFINITION

Temporary facial paralysis that can impair daily activities, social communication, consciousness, and the quality of life.
It happens when the nerve that controls facial movement on one side becomes irritated. A abrupt sensation of weakness or paralysis on one side of the face is typically when Bell's palsy occurs.

SYMPTOMS

  • Facial weakness
  • A droopy mouth
  • An inability to make facial expressions, such as smiling or frowning
  • Difficulty pronouncing certain words
  • Dry eye and Mouth
  • Altered taste
  • Drooling
  • Sensitivity to sound
  • Difficulty eating and drinking
  • Muscle twitches in the face
  • Irritation of the eye on the involved side
  • Headache
  • Pain in the ear, cheek, or teeth
  • Vision changes
  • Weakness of arms or legs

    CLINICAL PRESENTATION 

1-The corners of the lips droop, the forehead unfurrows, and the nasolabial fold disappears.

2-The lower lid droops and the eyelids won't close; when they do, the eye rolls upward (Bell's phenomenon). 

3-Eye irritation is frequently caused by inadequate lubrication and prolonged exposure. 

4-Tear production reduces, but because the lids can no longer be controlled, tears might run out of the eye easily, giving the appearance that the eye is crying excessively. 

5-The affected side of the mouth may accumulate food and saliva, which then may pour out of the corner.

CAUSES


The cause is frequently unclear. 
Herpes simplex or herpes zoster, two different herpes infections, could be at effect. Additional conditions that could result in Bell palsy include:

AIDS or HIV infection
Lyme illness
infected middle ear
Sarcoidosis 

Bell palsy risk may be increased by diabetes and pregnancy

DIAGNOSIS

Identifying whether a problem with the peripheral nervous system or the central nervous system is to responsible for facial weakness is the first step in making a diagnosis
This is done quickly with some questions and observation

DIAGNOSIS OF PERIPHERAL AND CENTRAL FACIAL WEAKNESS

CENTRAL FACIAL WEAKNESS

PERIPHERAL FACIAL WEAKNESS

lesion is contralateral to the weakness in the lower facial area

lesion is Ipsilateral to the weakness in both upper and lower facial area

Furrows both sides of the forehead and  can close both eyes, when the patient responds to the request “show me your teeth”

(Fig A)

 

Furrow unilateral side of forehead and close only one eye , when the patient responds to the request “show me your teeth”

(Fig B)

VOLUNTARY CENRTAL FACIAL WEAKNESS

weakness in the lower facial area is greater when the patient responds to the request “Show me your teeth” than when the patient smiles spontaneously

 

 INVOLUNTARY CENTRAL FACIAL WEAKNESS

 weakness in the lower facial area is greater when the patient smiles spontaneously than when the patient responds to the request “Show me your teeth.”

 

 

SITE OF INJURY

PERIPHERAL FACIAL WEAKNESS 
Peripheral nerve, pons 

CENTRAL FACIAL WEAKNESS
Contralateral hemisphere

When asked to close your eyes (to test the upper facial area) and show me your teeth (to test the lower facial area), the patient's response is the best indicator of facial weakness 

CLINICAL EXAMINATION

Throughout the interview, keep an eye out for Asymmetry; particularly pay attention to blinking, the nasolabial folds, and the corners of the mouth.
General assessment: otoscopy, palpation for lumps close to the neck and face, and skin examination

As the patient is being examined, ask them to:
Both brows are raised.
Immediately close both eyes
Smile
Puff up your cheeks
Lips are pursed
Display both the top and bottom teeth (grimace)

If clinically necessary, evaluate particular Sensory function.
Facial and ear sensation
the tongue's front two thirds have taste receptors.
Check your Reflexes

Orbicularis reflex: touch your glabella to see asymmetry in your blinking pattern.
Watch your eyeballs as they travel upward while having your eyelids closed ( bell phenomena)

TEST


Electromyography (EMG), which measures variations in electrical activity during movement and while the muscle is at rest, inserts small wire electrodes into a muscle. EMGs can identify the presence of nerve injury, as well as assess its severity and degree of involvement.
Blood tests can occasionally be used to determine additional issues that are present, such as diabetes and specific infections.
Diagnostic imaging procedures like magnetic resonance imaging (MRI) or computed tomography (CT) scans can evaluate the other nerves and rule out other structural sources of pressure on the facial nerve, such as an artery compressing the nerve.

TREATMENT

MEDICATIONS

  • Steroids if you have newly-onset
  • To reduce swelling and inflammation and improve the chance of regaining facial nerve function in Bell's palsy patients, oral steroids should be taken as soon as symptoms appear, ideally within 72 hours.
  • In addition to steroids, antiviral medications may improve the likelihood that facial function may return, however their value has not yet been thoroughly studied.
  • A number of analgesics, including aspirin, acetaminophen, and ibuprofen, can reduce pain.

EYE PROTECTION

Protecting your eye should come first. The eye is more susceptible to damage from dryness and particles when you can't rapidly and completely close your eye. The cornea, the transparent front portion of the eye that covers the iris, pupil, and front chamber of the eye, can be scratched by debris, which could permanently impair your eyesight. Physical therapist will right away demonstrate certain eye safety measures for you, like:
  • Using both commercial and custom patches
  • Establishing a routine for refreshing ocular fluids
  • With your fingers, gently close the eye
PHYSICAL REHABILITATION 

ELECTROTHERAPY is most commonly used to reestablish facial control and movement 


DOSAGE OF ELECTROTHERAPY 
GALVANIC (continuous) and FARADIC (pulsating) 
0.2-100 Hz
10 to 30 min 
For denervated muscle 
5 to 10 unidirectional and rectangular pulses used per day 
30 to 300 ms pulse duration 
4 or more seconds between pulses are used
OTHER MODALITIES INCLUDE 
Ultrasound
Laser
Pulsed Electromagnetic Wave 
Infrared Ray


    Open and close mouth as you would with smiling
    Perform 30 times. 4x / day



   Slowly pucker mouth then relax
   Perform 30 times. 4x / day

 Slowly open eyes wide open and lift eyebrows
 Perform 30 times. 4x / day


    Slowly frown then relax
   Perform 30 times. 4x / day

Slowly close eyes tightly and relax
Perform 30 times. 4x / day

FACIAL EXERCISES



EXERCISES TO HELP CLOSE THE EYES

SURGERY

SURGICAL DECOMPRESSION 
Surgery should only be considered in patients who have complete paralysis, a motor amplitude reduction of more than 90% compared to the unaffected side on a nerve conduction study, and no volitional activity on a needle examination.















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