Bells palsy
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Transcript of Bells palsy
11/04/2023 BELLS PALSY 1
Bell’s Palsy:
PRESENTED BY-DR NANDANI KUMARIPG II YEAR
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Motor nucleus of VII CN is antero lateral to VI CN
nucleus
Parasympathetic fibres
Red line motor fibers
Visceral afferent fibres
11/04/2023 BELLS PALSY 4 Submandibular ganglion
Submandibular gland
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Bell’s Palsy Defined
It is an idiopathic paralysis of the facial nerve of sudden onset.
Unilateral lower motor neuron paralysis of sudden onset,not related to any other disease elsewhere in the body.
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Who is Bell ?
Charles Bell known for his studies on the nervous system and
the brain. In the 19th century discovered that lesions of the 7th
cranial nerve causes facial paralysis.
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Facial Nerve
Each nerve controls: Eye blinking and closing Facial expressions
Smiling and frowning Tear glands Saliva glands Muscle of small bone in middle of ear called the stapes Taste sensations
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Cause
Unknown cause Evidence shows that reactivated herpes
simplex virus (HSV) may be involved in some cases.
Reactivation of the HSV causes inflammation, edema, ischemia, and eventual demyelination of the facial nerve, causing pain and alterations in motor and sensory function.
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May be caused by a viral infection Viral meningitis Herpes simplex
Headaches Chronic ear infections High blood pressure Diabetes Sarcoidosis Tumors Lyme disease trauma
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Because it's swollen, the nerve gets compressed as it passes through a small hole at the base of the skull, which causes the symptoms of Bell's palsy.
Bell's palsy can affect people of all ages, but it is most common in adults.
People with diabetes and pregnant women are more likely to develop Bell's palsy.
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Examination
Differentiate between upper and lower motor neurone lesion
UML: frontalis is spared allowing normal furrowing of brow and eye blinking
LML: all muscles of facial expression are affected
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Evaluation
Careful history – timing Associated symptoms recurrent
Physical exam CT/MRI Electrophysiology
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S/S Varies from person to person
Comes on suddenly Mild to total paralysis
Weakness, twitching on one of both sides of the face
Facial and eyelid droop Drooling Dryness of eye or mouth Impairment of taste Excessive tearing of eye
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Pain behind the ear may precede the paralysis by a day or two .
Impairement of taste is present to some degree in all cases –rarely beyond second week of paralysis.
Hyperacusis or distortion of sound in ipsilateral ear ---paralysis of stapedius muscle.
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Patient feels stiffness of face pulled to one side.
Ipsilateral restriction of eye closure, difficulty with eating ,fine facial movements.
Disturbance of taste –chorda tympani fibres Hyperacusis—fibers to stapedius
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BELL’S PHENOMENON
Normally on closing the eye ,the eyeball moves upwards and inwards.
This is on the affected side due to ineffective closure of the eyelids.
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Clinically Corner of mouth droops Skin folds effaces Forehead is unfurrowed Eyelids will not close Eye on the paralysed side rolls upward –
BELL’S PHENOMENON Lower lid sags and falls away from conjunctiva Tearing. Saliva may dribble from the corner of the mouth Heaviness or numbeness of the face
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House-Brackmann grading system Grade I - Normal Grade II - Mild dysfunction, slight weakness on close
inspection, normal symmetry at rest Grade III - Moderate dysfunction, obvious but not
disfiguring difference between sides, eye can be completely closed with effort
Grade IV - Moderately severe, normal tone at rest, obvious weakness or asymmetry with movement, incomplete closure of eye
Grade V - Severe dysfunction, only barely perceptible motion, asymmetry at rest
Grade VI - No movement
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Diagnosed
There are no specific lab tests to confirm diagnosis Will exam for upper and lower facial weakness Electromyography
Confirm presence of damage and determine severity MRI and CT
causes of pressure on nerve
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Differential diagnosis
Stroke Herpes zooster virus Lyme disease
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Prognosis
80% patients recover within a few weeks.2-12 weeks.
10%--permanent disfigurement.long term sequelae.
8%--recurrence Best clinical guide to progress is the severity of
the palsy during the first few days after presentation.
Recovery of taste precedes motor function.
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If recovery of taste occurs in first week –good prognostic sign.
Early recovery of motor function in the first 5-7 days— most favourable prognosis.
Recurrence is due to reactivation of virus,pregnancy.
Interval between periods is not predictable.
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Treatment
Controversial Symptomatic
Protection of eye during the sleep -patch Massage of the weakened muscles Lubricating eye drops
Prednisolone 60-80 mg/day in divided doses intial 4-5 days,then taper over next 7-10 days. Decreases the possibility of permanent paralysis From swelling of facial nerve in facial canal. Decreases the severe pain.
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Medical treatment
Acyclovir 400 mg 5 times/day Famciclovir and valacyclovir 500 mg
bid
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Surgical treatment
Facial nerve decompression Indication
Completely paralysis Appropriate time for surgery is 2-3 weeks
after paralysis.
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Electrophysiology
Treatment plan based on 16% of patients who do not fully recover
Several tests used for prognosis Measure amounts of neural degeneration occurred
distal to injury by measuring muscle response to electrical stimulus
Able to differentiate nerve fibers undergoing Wallerian degeneration.
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Temporal bone fractures
Signs bleeding from the external canal hemotympanum step-deformity of the osseous canal conductive hearing loss (longitudinal fracture) sensorineural hearing loss (transverse fracture) CSF otorrhea facial nerve involvement (20% of longitudinal
fractures and 50% of transverse fractures)
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Longitudinal VS Transverse
Type of injury
Longitudinal
Transverse
Incidence 70-90% 10-20%
Site of injury
Temporal , Parietal area
Occipital , Frontal area
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Sequelae
Long delay in the onset of recovery—3months Regeneration of nerve –2 years Incomplete
Crocodile tears Facial spasms
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That’s interesting… Famous people that have had Bell’s palsy
Roseanne Barr, American actress and comedian Stevie Benton, Bassist for Texas rock band, Drowning Pool Pierce Brosnan, Irish actor and producer George Clooney, American actor, director, producer and
screenwriter Alexis Denisof, Actor Graeme Garden, British comedy writer and performer, who
has written about his experiences with the condition Tony Gonzalez, American NFL football player Jane Greer, actress, had when 15 y/o
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The list goes on Katie Holmes, Actress Ralph Kiner, American baseball player in the 1940s and 1950s Amy Goodman, American journalist and author Curtis LeMay, was a general in the United States Air Force and the vice
presidential running mate of independent candidate George C. Wallace in 1968 Ralph Nader, American author, activist, politician Jim Ross, professional wrestling announcer for WWE RAW Rick Savage, British musician and bassist for Def Leppard Jamey Sheridan, American actor. His condition was written into the show Law
and Order: Criminal Intent and his character Captain James Deakins also had Bell's palsy.
Joseph C. Wilson, American diplomat Milo Ventimiglia, Actor
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THANKS
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