BELL’S PALSYBELL’S PALSY BY: RANDY BONNELL BY: RANDY BONNELL

Pathophysiology Pathophysiology

Actual pathophysiology is unknown Actual pathophysiology is unknown A popular theory is the nerve increases in A popular theory is the nerve increases in

diameter and becomes compressed as it diameter and becomes compressed as it courses through the temporal bone. courses through the temporal bone.

FrequencyFrequency

The incidence of Bell palsy in the United The incidence of Bell palsy in the United States is approximately 23 cases per States is approximately 23 cases per 100,000 persons 100,000 persons

Clinical manifestationsClinical manifestations

There is usually an abrupt onset of There is usually an abrupt onset of numbness or a feeling of stiffness or numbness or a feeling of stiffness or drawing sensation of the face drawing sensation of the face

The face appears asymmetric, with The face appears asymmetric, with drooping of the mouth and cheek drooping of the mouth and cheek

Other symptoms may be…….Other symptoms may be…….

More Clinical More Clinical manifestations manifestations

Loss of tasteLoss of taste Reduction of saliva (on affected side)Reduction of saliva (on affected side) Pain behind the earPain behind the ear Ringing in the ear or other hearing lossRinging in the ear or other hearing loss Difficulty swallowing Difficulty swallowing

Race/Sex/Age Race/Sex/Age

Incidence of Bell palsy Incidence of Bell palsy appears to be slightly appears to be slightly higher in persons of higher in persons of Japanese descent Japanese descent

No difference exists in No difference exists in sex distribution in sex distribution in patients with Bell palsy patients with Bell palsy

The incidence is highest The incidence is highest in persons aged 15-45 in persons aged 15-45 years years

Lab Studies Lab Studies

No specific laboratory tests exist to No specific laboratory tests exist to confirm the diagnosis of Bell palsy confirm the diagnosis of Bell palsy

Medical management Medical management

There is no specific therapy for bells There is no specific therapy for bells palsy.palsy.

Electrical stimulation or warm moist heat Electrical stimulation or warm moist heat along the course of the nerve may be along the course of the nerve may be helpfulhelpful

Nursing interventions Nursing interventions

Protection of the eye when the eyelid Protection of the eye when the eyelid does not closedoes not close

Massage of the affected area is Massage of the affected area is sometimes recommended sometimes recommended

Do face exercises ( closing eyes, puffing Do face exercises ( closing eyes, puffing out cheeks, wrinkling the forehead)out cheeks, wrinkling the forehead)

Keeping the affected eye moistKeeping the affected eye moist

Prognosis Prognosis

Prognostically, patients fall into 3 groups Prognostically, patients fall into 3 groups with roughly equal numbers in each with roughly equal numbers in each group. group.

Most patients develop an incomplete Most patients develop an incomplete facial paralysis during the acute phase facial paralysis during the acute phase

Of patients with Bell palsy, 85% achieve Of patients with Bell palsy, 85% achieve complete recovery complete recovery

The groups are………. The groups are……….

Group 1 regains complete recovery of facial Group 1 regains complete recovery of facial motor function without sequelae motor function without sequelae

Group 2 experiences incomplete recovery of Group 2 experiences incomplete recovery of facial motor function, but no cosmetic defects facial motor function, but no cosmetic defects are apparent to the untrained eye are apparent to the untrained eye

Group 3 experiences permanent neurologic Group 3 experiences permanent neurologic sequelae that are cosmetically and clinically sequelae that are cosmetically and clinically apparent apparent