1. Neurolgy Chapter of IAP
Bell’s Palsy
                                                
Neurolgy Chapter of IAP

2. Neurolgy Chapter of IAP
Bell’s Palsy
Characterized by:
Peripheral facial paralysis
Acute benign cranial polyneuritis
Acute disorder characterized by a disruption of the motor branches of cranial nerve VII on one side of the face. (in absence of stroke)
Neurolgy Chapter of IAP

3. Neurolgy Chapter of IAP
Bell’s Palsy
Can affect any age group, though more common from
Etiology unknown; though reactivated herpes simplex may be involved.
Reactivation causes edema, inflammation, ischemia, and eventual demyelination of the nerve, creating pain and alteration in motor and sensory function.
Neurolgy Chapter of IAP

4. Clinical manifestations
Benign, with 85% of people recovering in 6 months-remaining 15% have some asymmetry of facial muscles
Neurolgy Chapter of IAP

5. Clinical manifestations
Often accompanied by an outbreak of herpes vesicles in or around the ear.
Pain around or behind the ear
Fever, tinnitus, hearing deficits
Flaccidity of the affected side of the face with drooping of the mouth accompanied by drooling DT paralysis of the facial nerve (motor branches)
Neurolgy Chapter of IAP

6. Clinical manifestations
Inability to close the eyelids, with an upward movement of the eyeball when closure is attempted; lower lid may turn out
Wide palpebral fissure (opening between eyelids)
Flattening of the nasolabial fold
Inability to smile, frown, or whistle
Unilateral loss of taste
Altered chewing ability; loss of or excessive tearing
Neurolgy Chapter of IAP

7. Neurolgy Chapter of IAP
Complications
Psychological withdrawal DT changes in appearance,malnutrition or dehydration, mucous membrane trauma, corneal abrasion, muscle stretching, and facial spasms and contractures.
Neurolgy Chapter of IAP

8. Neurolgy Chapter of IAP
Diagnostic Studies
Diagnosis made on basis of symptoms in the absence of other causes of paralysis such as stroke.
No definitive test
EMG may determine nerve excitability or absence
Neurolgy Chapter of IAP

9. Therapeutic Management
Corticosteroids- drug of choice
Prednisone may be started immediately!
Best if initiated before paralysis is complete
Taper off over 2 weeks
Decrease edema and pain
Analgesics may be needed for pain
Antivirals : Acyclovir (Zovirax) and Famvir because HSV is implicated in 70% of cases.
See Lewis Nursing Implementation
Neurolgy Chapter of IAP