Bells Palsy Neurolgy Chapter of IAP Bells Palsy
Bell’s Palsy • 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
Bell’s Palsy • Reactivation causes • Can affect any age edema, group, though more inflammation, common from 20 -60. ischemia, and • Etiology unknown; eventual though reactivated demyelination of the herpes simplex may nerve, creating pain be involved. and alteration in motor and sensory function. Neurolgy Chapter of IAP
Clinical manifestations • Benign, with 85% of people recovering in 6 months-remaining 15% have some asymmetry of facial muscles Neurolgy Chapter of IAP •
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
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
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
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
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 1719 -1720 - Nursing Implementation Neurolgy Chapter of IAP
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