Bell’s Palsy – Diagnosis And Treatment

Bell’s Palsy – Diagnosis And Treatment

Facial palsy refers to the paralysis of facial muscles.

Facial palsy is of two types

• Upper motor neuron palsy
• Lower motor neuron palsy or Bell’s palsy

Upper Motor neuron Palsy

• It affcets mainly muscles of lower part of face and is never complete.
• It is seldom isolated palsy.
• The emotional movements are preserved.
• There is no muscle contracture.
• There is no reaction of degeneration.
• Electromyography and nerve conduction is normal.

lower Motor neuron Palsy or Bell’s Palsy

It is also called as 7th nerve paraplegia or facial palsy.

Bell’s Palsy Etiology

• Cold: It occurs after exposure to cold.
• Trauma: Extraction of teeth or injection of local anesthetic may damage the nerve and causes subsequent paralysis.
• Surgical procedure: Such as removal of parotid gland tumor in which the facial nerve is sectioned can also cause facial paralysis.
• Tumors: Tumors of the cranial base, Parapharyngeal space and infratemporal fossa cause facial nerve palsy.
• Familial: Familial and hereditary occurrence is also reported in case of Bell’s palsy.
  Facial canal and middle ear neoplasms may lead to Bell’s palsy.

Bell’s Palsy Clinical Features

• Bell’s Palsy is in older age group.
• Female predilection is most common.
• There is presence of paralysis over one side of the face.
• Drooping of angle of mouth is present over the affcted side and saliva is drooling from the affcted side.
• Patient is unable to raise the eyebrow of the affcted side.
• Patient is unable to close the eye over affcted side and tears continuously roll down.
• Eyeball rolls upward when attmpted to close the eye, this is known as Bell’s phenomenon.
• Over the affcted side, patient has lost the taste sensation.
• Patient complaints of pain in or behind the ear.
• Presence of numbness over the affcted side of face.
• Patient has mask-like appearance when he/she tries to smile.
• There is diffilty in blowing or clenching
• Obliteration of nasolabial fold
• Presence of wide palpebral fisure
• Presence of Epiphora.

Bell’s Palsy Treatment

Medicinal Treatment

• Patients with Bell’s palsy have excellent prognosis.
  Treatment of Bell’s palsy is controversial as spontaneous recovery is present.
• Treatment is given to the patients who have onset of paralysis under 1 to 4 days of an initial visit.
• Corticosteroids, i.e. prednisolone 1 mg/kg or 60 mg per day for 6 days followed by the taper of 10 days.
• Antiviral drugs can be given in the patients in which bell’s palsy is associated with herpes infection.
• In Bell’s palsy eye of the patient is at risk for drying which cause corneal abrasion and corneal ulcer.
  Eye care consists of inducing the artificial tears in day-time along with eyeglasses. At night, eye lubricant can be used.

Bell’s Palsy Surgical Treatment

• Surgical treatment for Bell’s palsy is surgical decompression and anastomosis of the nerve.
  In this facial and hypoglossal nerve get anastomosed which helps in restoring the partial function.
• Nerve grafting using greater auricular nerve, sural nerve,lateral cutaneous nerve of thigh or hypoglossal nerve.
• Suspension of angle of mouth to zygomatic bone using temporal fascia sling.
• Lateral tarsorrhaphy: This prevents corneal ulceration
• Medial canthus reconstruction: To decrease epiphora
• Cross facial nerve transplantation from opposite side using its insignifiant branches
• Dynamic neurovascular muscle graft
• Upper lid gold weights to protect cornea