Bell’s Palsy – Symptoms and Causes

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Bell’s palsy

Bell’s palsy is an acute apparently isolated, lower motor neuron facial palsy.

Bell’s palsy Etiology

• Cold: It usually occurs after exposure to cold.
• Trauma: Extraction of teeth or injection of local anesthetic may damage to the nerve and 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 after cause 7th nerve palsy.
• Familial: Familial and hereditary occurrence is also reported in case of Bell’s palsy.
• Facial canal and middle ear neoplasm.
• Herpes simplex—viral infection.

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Bell’s palsy Clinical Features

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Bell’s palsy Investigations

Electromyography is of prognostic importance.

• If signs of denervation are present after 10 days, i.e. axonal degeneration is present and recovery is incomplete or delayed.
• If there is incomplete denervation in less than 7 days the prognosis is good.
• Fibrillation potential after 2 weeks is suggestive of wallerian degeneration.

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Bell’s palsy Management

• Local heat: Infrared or moist heat over the face or parotid region or both if there is tenderness of nerve trunk.
• Local treatment ofmuscles: The patient should massage the facial muscles with bland oil for twice a day for 5 min.
  The massaging movements should start from the chin and lower lip and are directed upwards.
  With return offunction the patient should practice movements of various muscles of face before a mirror.
• Prevention offacial sagging: Application of strips of adhesive tape is done to lift up the angle of mouth.
  Tape is attched to the temple and extends down in a V shaped fashion to upper and lower lips.

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• Protection of eye: It is done with dark glass or eye patch.
  Mild zinc boric solution is used to wash the eye to prevent conjunctivitis.
• Corticosteroids: If seen under a week of onset. Prednisolone 40mg/day for 4 days and in tapering doses for over next 6 days helps by reducing secondary edema.
• Anti–virals: Acyclovir, Valacyclovir or Famciclovir in combination with steroids, ifstarted within 3 days of on set.
• Surgery: Decompression of facial nerve in second or third week cannot inflence favorably natural course of Bell’s palsy. Cases which fail to recover after 9 months in them anastomosis of facial nerve with accessory or preferably hypoglossal nerve is considered, or plastic surgery in cases of total paralysis with atrophy of muscle.

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