Diseases Of Nerves And Muscles
Question.1. Write notes on Bell’s palsy.
Or
Write short note on Bell’s Palsy.
Or
Write in brief on Bell’s palsy.
Or
Write short essay on Bell’s palsy.
Answer. Bell’s palsy is an acute apparently isolated, lower motor neuron facial 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 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.
Read And Learn More: Oral Pathology Question And Answers
Clinical Features
- Symptoms
- Sudden following exposure to chill or without any apparent precipitating causing maximum paralysis in 24 hours.
- Post auricular pain is common.
- Spontaneous complaints of loss of sense of taste,hyperacusis (progressive loss of hearing and watering of the eye).
- Sweating is less on the affected side.
- Signs
- Forehead is not wrinkled and frowning is lost.
- Eye of the affected side is not closed and on attempting closure eyeball turns upwards and outwards.
- On showing teeth the lips do not separate on the affcted side.
- Cheeks puff out with the expiration because of buccinator paralysis and food collects between the teeth and paralyzed cheek.
- Base of the tongue is lowered.
- Deafness may result.
Management
- Local heat: Infrared or moist heat over the face or parotid region or both if there is tenderness of nerve trunk.
- Local treatment of muscles: Patient should massage the facial muscles with bland oil for twice a day for 5 min.
- 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: Prednisolone 60 mg/day along with amoxicillin 250 mg 8 hourly help in reducing edema round about the nerve.
- Heavy doses of vitamin B12 1000 µ gm per day IM is given.
- Galvanism: It is given two weeks after the onset of paralysis three times in a week.
- Surgery: Plastic surgery is preferred.
Question.2. Write note on trigeminal neuralgia.
Or
Write short note on trigeminal neuralgia
Answer. Trigeminal neuralgia is also called as Tic Douloureux.
A disorder characterized by the paroxysmal (occurring repeatedly without warning) attacks of neuralgic pain with affection of one or more divisions of trigeminal nerve.
The pain involves the first and second divisions equally and rarely the fist.
Clinical Features
- Pain is unilateral and is confined to one of the three divisions of nerve. Pain is sharp and onset is sudden. The pain is only of a few seconds.
- During attcks there is flushing of face, i.e. redness of the face.
- Dilatation of pupil is present.
- There is excessive lacrimation.
- After repeated attcks skin becomes shiny and hair in the area become gray.
Sometimes secretion of nasal mucus and saliva may occur in the side of pain.
Etiology
Trigeminal neuralgia is spontaneous and following exposure to cold wind, blow on face, or chewing or eating, drinking hot or cold fluid, and washing the face.
Management
- Elimination of all possible sources of infection.
- Drugs.
- Analgesics: Potent analgesics must be used with caution because of danger of habituation.
- Carbamazepine: 100200 mg BD a day and increasing the dose to 600800 mg per day.
- Phenytoin sodium: 0.1 gm TDS when carbamazepine is not tolerated.
- Vitamin B12: 1000 micrograms IM daily for two weeks.
- Injection of alcohol: It is given in affected nerve or gasserian ganglion. If more than one division is affected inject 10 minims of 90% alcohol after local anesthesia with 2 to 3 drops of procaine.
- Surgery: Selective or complete preganglionic selection of trigeminal root.
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