Bell's Palsy

This presentation is about Bell’s palsy which is a facial paralysis of acute onset presumed to be due to non-suppurative inflammation of unknown etiology of the facial nerve within its canal above the stylomastoid foramen.

1. BELL’S PALSY
S.CHRISTY SOPNA
PHYSIOTHERAPIST

2. DEFINITION
Bell’s palsy is a facial paralysis of acute onset presumed to be due to non-
suppurative inflammation of unknown etiology of the facial nerve within its canal
above the stylomastoid foramen.

3. ETIOLOGY
uHistory of exposure of the ear to extreme cold
uWater retention in pregnancy
uInfection of the ear(otitis media )
uUpper respiratory tract infection
uIdiopathic
uVIRAL INFECTIONS –Herpex simplex
Epstein Barr
varicella-zoster
uBACTERIAL INFECTION –Borrelia burgdorferi

4. Bells palsy
uDamage to the 7thcranial nerve (FACIAL NERVE)
uAFFECT :
uLACRIMAL GLAND-produces tears
uMUCOUS MEMBRANE –nose, mouth and nasopharynx
uSUBMANDIBULAR, SUBLINGUAL GLAND –produces saliva
uAffect taste in anterior 2/3rdof tongue

5. BELL’S PALSY VS FACIAL PALSY
BELL’S PALSY FACIAL PALSY
LMN(lower motor neuron lesion )UMN (upper motor neuron lesion)
The nerve get affected in its nerve
course from stylomastoidforamen
Lesion in brain or brainstem
All muscles paralysedon affected
side
Paralysisof muscles on the lower half
of the face on the contralateral side
of face

7. SYMPTOMS
uDrooping eyelid
uAbsence of nasolabial fold
uDrooping mouth
uDryness in affected eye or mouth
uHypersensitivity to loud noises (HPERACUSIS)
uLoss of taste sensation on anterior 2/3rdof tongue

9. MUSCLES AFFECTED
uFrontalis
uCorrugator supercili
uOrbicularis oculi
uNasalis
uLevatorlabisuperiorisand inferioris
uRisorius
uBuccinator
uDepressor labiorbicularis oris
uMentalis

10. TYPES OF NERVE INJURY
uNEUROPRAXIA
uAXONOTOMESIS
uNEUROTOMESIS

11. CASE STUDY
A 50 year old man came with a Condition of weakness in right side face, Slurring of
speech, inability to close right eye, deviation of mouth to left side & reduced
sensation in the right side tongue, Thus accumulation of food in right side and
drooling of water therefore the patient complains severe pain in the nerve course.

12. ON OBSERVATION
uIncomplete closure of eye
uLeft side deviation of mouth
uSagging face
uAbsence of nasolabialfold

13. ON PALPATION
uDryness of face
uSaggy muscles

14. SPECIAL TESTS
uBells phenomenon –positive
uMarin amatphenomenon –negative

15. EXAMINATION
uMUSCLE POWER ASSESMENT
uHousebrackmannfacial nerve grading system
uSunnybrook facial grading system
uFaradic galvanic test –to find out whether the nerve is innervated or
denervated
uStrength duration curve -to find out whether the nerve is innervated ,
partially innervated or denervated

18. PHYSIOTHERAPEUTIC TREATMENT
uElectrical stimulation –surged faradic and interrupted galvanic
uInfrared(IR) and short wave diathermy (SWD)–to increase circulation to resolve
inflammation
ufacial massage –upward direction
deep friction massage and kneading
uTaping or splinting –eye and mouth
uEye care –instruct patient to wear goggles
uVisual feedback exercise
uStrengthening exercise
uBalloon blowing
uCandle blowing
uTelling vowels a,e,I,o,u

20. FUNCTIONAL SCALING
SCALE PRE INTERVENTION1stWEEK 2ndWEEK
SUNNY BROOK 55302

21. THANK YOU