BELLS PALSY
seventh cranial nerve at the geniculate ganglion. Due to the
DEFINISI
Bell’s palsy is an acute, unilateral paresis or paralysis of
the face in a pattern consistent with peripheral nerve
dysfunction, without detectable causes.
- Bell's palsy is the most common peripheral paralysis of the
seventh cranial nerve with an onset that is rapid and
unilateral
F.RESIKO
-pregnancy dan DM,obesitas,hipertensi.
-rekativasi virus HSV tipe-1 DNA (ditemukan di endoneurial
fluid dan otot posterior auricular). Epstein-Barr virus
- Viral infection, vascular ischemia, autoimmune
inflammatory disorders, and heredity.
EPIDEMIOLOGI
pria=wanita(ada yg bilang insiden meningkat pada wanita
hamil trimester ketiga)
-sering pada pasien diabetes dan hipertensi.
- with a peak incidence between the ages of 10 and 40.
MANIFESTASI KLINIS
-onsetnya sangat mendadak,
-weakness maximal sampai 48 jam-->general rule
- nyeri dibelakanh telinga selama 1/2 hari bisa mendahului
paralisis.
- sensasi perasa lost unilateraljarang pesrsisten selama
2mgg,tanda lesi meluas ke proximal di mana chorda
tymphani menyendi dengan nervus fasial.
- hiperacusispada telinga ipsilateral menandakan paralisis
otot stapedius.
-mild CSF lymphocitosis
-geniculate ganglion dan saraf wajah swelling dan
membesar uniform(deteksi MRI). syaraf yg swelling
entrapment di os temporal.
-biasanya sembuh dalam bbrp mgg atau bulan, denervasi
setelah 10 hari menandakan degenerasi axon sehingga ada
delay 3 bulan sebelum terjadi regenerasi dan itu juga bisa
aja incomplete.
- paralisis incomplete biasanya terjadi pada mgg pertama-
->tanda gold prognostic factor.
PATOFISIOLOGI
-akut--> inflamasi pada persarafan wajah oleh sel
mononuclear akibat infeksi atau proses imunitas.
-ada reaktivasi virus di ganglion geniculate.
-vaksinasi influenza intranasal . enterotoxin E.Coli sebagai
adjuvant atau reaktivasi virus latent.
-interval episode reaktivasi bisa sampai 10 tahun.
Bell's palsy is thought to result from compression of the
narrow opening of the facial canal, inflammation causes
compression and ischemia of the nerve. The most common
finding is a unilateral facial weakness that includes the
muscles of the forehead.
DIAGNOSIS BANDING.
1. Lyme disease--> facial palsy unilateral/bilateral, paling
sering akibat infeksi Borrelia Burgdorferi.
2. Ramsay Hunt Syndrome-->reaktivasi HZV di geniculate
ganglion mengakibatkan facial palsy berat berhubungan
dengan erupsi vesicular di meatus acusticus external,
kadang di faring serta nervus cranial dermatom (terutama
N.VIII).
3. sarcoidosis dan Guillain barre syndrome--> fasial palsi
bilateral.
4.lepra
5. DM--> neurophaty
- sjogren syndrome dan amyloidosis.
6. Tumor((badan carotis,cholesteatoma.dermoid))--> invasi
pada os tempora meneybablkan facial palsy tapi onsetnya
insidous dan progresive.
harus dibedakan lokasi lesinya supranuclear atau nuclear.
1.lesi supranuclear berhubungan dengan emosipnal,dan
gerakan volunter wajah serta ada bbrp paralisis dari lengan
daan paha atau aphasia.
2. lesi nuclear.
DIAGNOSIS
1, manifestasi klinis typical
2. no risk factor or gejala yg mendahului.
3. absence lesi kutaneus herpes zooster di meatus
acusticus externale
4. pemeriksaan fisik abnormal pada nervus facial(terutama
N.VIII dekat nervus facial di junction pontomedullary dan di
os temporal.
- GBS--> lumbar puncture
-MRI--> swelling dan pembesaran nervus facial di bells
palsy idhiopatic.
The key physical exam finding is a partial or complete
weakness of the forehead. If forehead strength is preserved,
a central cause should be investigated.
History and physical examination guide the evaluation.
The House-Brackmann Facial Nerve Grading System can
be used to describe the degree of facial nerve weakness.
This grading system goes from a grade of I (no
weakness) to VI (complete weakness). If the presentation
is consistent with Bell's palsy, there are no required lab
or radiographic tests. If there are atypical features,
patients may need to be evaluated for a central cause of biasanya sembuh dalam bbrp mgg atau bulan, denervasi
their symptoms. Likewise, Lyme disease testing is based setelah 10 hari menandakan degenerasi axon sehingga ada
on a history of possible tick-borne illness. The routine delay 3 bulan sebelum terjadi regenerasi dan itu juga bisa
testing for Lyme disease is not recommended without aja incomplete.. indra perasa akan membaik duluan baru
other findings of the disease such as a history of tick bite, motoriknya baiknya dalam mgg pertama.tapi lebih baik lagi
skin rash or arthritis. Diabetic testing should not be kalau gejala motoric hilang 5-7 hari lebih awal.
performed as facial nerve palsy is not considered diabetic
neuropathy. There is no consensus on the optimal timing LYME DISEASE
of imaging for Lyme disease, but most sources
recommend after 2 months of no improvement of the
facial palsy. MRI is the imaging modality of choice. MRI
can detect facial nerve inflammation as well as ruling out
other conditions such as schwannoma, hemangioma or a
space-occupying lesion.[6]
There is a grading system for clinical evaluation of Bell
palsy. The grading system ranges from mild to severe
dysfunction.

TATA LAKSANA
- paper tape untuk menarik bagian atas palpebra agar bisa
tertidur dan mencegah corneal drying.
-pijat di daerah otot yg lemah.

-prednisolone 60-80 mg sehari selama 5 hari pertama dan

tapering off 5 hari kemudian.
- antiviral: valacyclovir 1000 mg perhari selama 5-7 hari
atau asiklovir 400 mg 5x/hari selama 10 hari.

lebih baik digunakan kombinasi antivirus dan prednisolon.

PROGNOSIS