Bell's Palsy
Definition:
It is an acute paralysis of the face due to non suppurative inflammation of the facial nerve near the stylomastoid foramen . usually unilateral,may be recurrent&sometimes run in families.Atiology:
1)exposure to air drafts usually preceed the onset:this may lead to ischaemia,oedama&compression of the nerve at the stylomastoid foramen.
2)It may 2ry to a neurotropic virus e.g. Herps Zoster.
3)It may be autoimmune,as evidenced by high levels of immunoglobulins in the patient.
2)one or two days later,there is complete paralysis of the facial muscles on the affected side of lower motor neuron lesion nature which are:
*obliteration of naso-labial fold.
*Dropping of the angle of the mouth with dripping of saliva.
*accumulatin of food behind cheek.
*inability to blow the cheek.
*inability to show the teeth properly.
*inability to raise eyebrows with absence of wrinkles of the forehead.
*inability to close the eye: when the patient attempt to close his eye, the eye ball rolls upward(Bell's Phenomena).
3)there may be impairment of taste on the anterior 2/3 of the tongue on the same side.
2)Vasodilators, vitamens B complex & Neostigmine.
3)Protection of the exposed cornea:eye ointment during sleep, sunglasses during day time.
2)Infrared irradiaton on the face.
3)Galvanic stimulation to the facial muscles.
2)facial nerve grafting.
3)Plastic surgery for residual facial asymmetry.
*occasionally aberrant reinnervatin occur where the regenerating facial fibers anastomose with trigeminal fibers. thus when the patient move his jaw while eating or speaking there may be:
_Winking( jaw winking)
2)It may 2ry to a neurotropic virus e.g. Herps Zoster.
3)It may be autoimmune,as evidenced by high levels of immunoglobulins in the patient.
Clinical Picture:
1)the onset is usually acute with pain behind the ear.2)one or two days later,there is complete paralysis of the facial muscles on the affected side of lower motor neuron lesion nature which are:
*obliteration of naso-labial fold.
*Dropping of the angle of the mouth with dripping of saliva.
*accumulatin of food behind cheek.
*inability to blow the cheek.
*inability to show the teeth properly.
*inability to raise eyebrows with absence of wrinkles of the forehead.
*inability to close the eye: when the patient attempt to close his eye, the eye ball rolls upward(Bell's Phenomena).
3)there may be impairment of taste on the anterior 2/3 of the tongue on the same side.
Treatment:
A)Medical:
1)Prednisolone tablets 30 mg/day or Synacten amp. I.M. for 2-3 weeks.2)Vasodilators, vitamens B complex & Neostigmine.
3)Protection of the exposed cornea:eye ointment during sleep, sunglasses during day time.
B)Physiotherapy:
1)Massage of the facial muscles.2)Infrared irradiaton on the face.
3)Galvanic stimulation to the facial muscles.
C)Surgical:
1)Decompression of the facial nerve.2)facial nerve grafting.
3)Plastic surgery for residual facial asymmetry.
Prognosis:
*most patients(80%)recover in 4-6 weeks; the remaining 20% need surgical intervention.*occasionally aberrant reinnervatin occur where the regenerating facial fibers anastomose with trigeminal fibers. thus when the patient move his jaw while eating or speaking there may be:
_Winking( jaw winking)
_Lacrimaton(crocodile tears)
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