BELLS PALSY

MALLIKARJUNA.V

INTRODUCTION

Cranial nerves are the nerves which takes origin in the brain, there are 12 pairs of cranial nerves are there in human body apart from the peripheral nervous system. Each cranial nerve has its own function.

FUNCTIONS OF FACIAL NERVE

Controls the muscles that moves the eye

brows, Close the eyes.

Move the mouth and lips. It also controls the tear glands, one of the

salivary gland and the taste buds in the front of the tongue.

The most common cranial nerves that are affected are :Trigeminal nerve (CN V), Facial nerve (CN VII), Vagus nerve (CN X), Glossopharengeal nerve (CN IX).

DEFINITION
Bells palsy is a disorder characterized by a disruption of the motor branches of the facial nerve(CN VII) on the one side of the face in the absence of any other disorders such as stroke.

INCIDENCE
Bells palsy is the most common cause of

facial paralysis worldwide, and one of the most common neurological disorder involving a cranial nerves. Disorder can occur at any age, but it is most frequently in 20-60 years of age group. Incidence is equal in both the gender as well as in race.

RISK FACTORS
Patient who have diabetes mellitus are more

than 4 times likely to develop the disorder than the general population. Women who are pregnant, have 3.3 times higher risk for bells palsy than the nonpregnant women. Bacterial infections such as Lyme disease, tuberculosis, syphilis, typhoid fever, frequent middle ear infections.

 Viruses such as influenza, infectious

mononucleosis. Neurological disorders such as Guillian barre syndrome, multiple sclerosis and neurosarcoidosis. Traumatic injury to the head or face. Tumors causing nerve compression.

CAUSES
Viruses : Herpes simplex virus, Herpes zoster virus, Epstein bar virus, Chicken pox, Mumps. Mycobacterium tuberculosis, Spirochete borrelia burgdorferi

Bacteria's :

Brain stem tumors.

Skull fractures.
Neurological conditions: Multiple sclerosis, Guillian barre syndrome. Cerebrovascular accident / stroke.

PATHOPHYSIOLOGY
Trauma/tumors/inflammation

Swelling of the nerve

Pressure is produced on the nerve Blocking of neuronal signals/ damaging the nerve Facial paralysis

CLINICAL MANIFESTATIONS
The severity of the symptoms depends on the

extent of facial nerve damage and varies from mild weakness to complete paralysis.
All the symptoms are on the same side of the lesion. The most common symptoms are facial weakness or paralysis, dry mouth and impairment in tasting.

 Paralysis of the facial muscles are one side of the face.

Paralysis of the upper eye lid with loss of

corneal reflex on the affected side. Loss of impairment of taste over the anterior 2/3rd of the tongue. Increased tearing from the lacrimal gland on the affected side.

 Impaired speaking. Drooling. Dizziness.

DIAGNOSTIC MEASURES
History collection and physical examination. In the physical examination all the defects on

the same side.

Observe the patients range of movement in

different part of the face (eg raising and lowering the eye brows, closing the eyes).

 Ask the patient to show his /her teeth and to

smile. Note if there is a weakness.

When the patient attempt to smile the lower

facial muscles are pulled to the opposite side of the face.

Eyes do not close.

LAB TESTS Blood sugar levels. IMAGING STUDIES CT/MRI scan can be used to detect infection, tumor, bone fracture or other abnormalities in and around the facial nerve. Electromyography(EMG) used to assess the injury by electrically stimulating the facial nerve.

MANAGEMENT
1. No curative treatment for Bells palsy.

2. Symptoms especially in the eye are treated to prevent permanent.

3. Treatment to reduce inflammation of the facial nerve.

MEDICAL MANAGEMENT

Corticosteroids : Prednisolone. Anti viral agents: Acyclovir. Analgesics : Diclofenac sodium.

SURGICAL MANAGEMENT
Indicated for those who do not complete recover.
These complex procedures are done on facial

nerve and muscles in order to reduce distortion of facial muscles and help to restore function. The three main procedures are: 1.Facial nerve repair and graft 2.Nerve substitution. 3.Muscle transportation.

1.Facial Nerve repair is the most effective procedure to restore facial function in patients who have suffered nerve damage from an accident or during surgery. It involves microscopic repair of nerve that has been cut. A Nerve graft replaces one that has been removed.

2.Nerve substitution is indicated when the nerve cannot be repaired in the conventional manner. In this procedure another cranial nerve involved in the facial movement is connected to the damage nerve takes over its function.

3.Muscle transportation is used in patients who have had facial paralysis for at least 2 years and are unlikely candidates for nerve repair or substitution.

This procedure involves the transfer of a muscle with its original nerve supply(a neuromuscular unit) to the affected area.

The temporalis muscle or masseter muscle (two muscles in the face are not controlled by the facial nerve) are moved and connected to the corner of the mouth to provide movement in the lower part of the face. In free muscle transfer, muscles from the leg are moved to the face to provide bulk and function.

Surgical decompression is done, where is performed in severe cases when the facial nerve is seriously deteriorating.

NURSING MANAGEMENT
Nursing management of patient with bells palsy focuses on prevention of injury and need to

provide psychological and emotional support. Eyes do not close, cornea must be protected from injury and from drying to prevent corneal ulceration and blindness, by instillation of artificial tears about every 2 hours. Sun glasses can help to protect the eyes from injury and reduce dryness by decreasing expose to wind.

 A eye lids may be taped or an eye patch may

be worn for protection. Frequent, small feedings of soft food should be given.
The simple technique of moist application,

massage, facial exercises can easily taught to patient.

Thorough oral hygiene must be carried out

after each meal.

 A special form of physical therapy called

facial retraining

COMPLICATIONS
Complications include Psychologic withdrawal, Malnutrition, Dehydration, Corneal abrasions, Muscle stretching, Facial spasms and Contractures.

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