BELL’S PALSY

Dr Rachakonda Rajkumar
M.B.B.S.,M.D (GEN.MED)
WHAT IS FACIAL PALSY?

 Weakness of facial muscles

 Temporary/Permanent damage of facial nerve

 FACIAL NERVE:
 Pons of the brainstem
 Mixed nerve
 Intracranial branches
 Extracranial branches
 Left & right
 five separate branches
 Field of innervation:
 Motor: 
 facial expression muscles, posterior belly of digastric muscle,
stylohyoid muscle, stapedius muscle.
 Special sensory: 
 taste from anterior two-thirds of the tongue
 Parasympathetic: 
 submandibular gland, sublingual gland, lacrimal glands
 FUNCTIONS OF FACIAL MUSCLES:
 Raising the eyebrows (frontalis)
 Closing the eyes (orbicularis oculi)
 Frowning (corrugator)
 Open mouth smiling (zygomaticus)
 Closed mouth smiling (risorius)
 Pouting (orbicularis oris)
 Lifting top lip (levator labii)
 Pulling lower lip down (depressor labii)
 Sticking bottom lip out (mentalis)
 Pulling jaw and corners of mouth gently down (platysma)
 Wrinkling nose (procerus/nasalis)
WHAT CAUSES FACIAL PALSY?

 Bell’s palsy (most common)

  Ramsay Hunt syndrome

 Surgical causes:
 acoustic neuroma /facial nerve tumour/parotid gland.

 Lymes disease (bacterial)

 Neurological conditions:
 Neurofibromatosis 2
 Guillain-Barré syndrome
 Charcot Marie Tooth disease
 Traumatic injury
 Birth trauma:
 caused by forceps or facial presentation delivery.

 Congenital conditions:
 such as an abnormal development of the facial nerve or muscle in
the womb.

 Rare genetic syndromes:

 Moebius syndrome or CHARGE syndrome.

 Stroke
BELL’S PALSY

 successfully respond to treatment within 72 hours of

onset
 Fear of stroke (USE B.E. F.A.S.T)
  ‘Bell’s palsy’:
 Scottish,Sir Charles Bell.

  lower motor neuron lesion

  inflammation around the facial nerve
 pressure causes facial paralysis on the affected side.
 Bell’s palsy is the most common cause of acute facial
paralysis.
  80 per cent of all cases of facial palsy.
 15 and 45 years of age.
 Mostly seen in 3rd trimester
 Common in winter
WHAT CAUSES BELL’S PALSY?

  Idiopathic condition
  viruses
 herpes,

 influenza

 respiratory tract infections

 depleted immune system
 stress
WHAT ARE THE SYMPTOMS OF BELL’S PALSY?

 Sudden onset
 number of hours, peaking at 72 hours

 Partial / complete paralysis of (usually) one half of the face

 inability to close the affected eye,
 ‘drooping’ of the affected side of the face.

 depending on the severity of the nerve damage.

 one per cent of cases, both sides of the face are affected.
 Sharp pain in the inner ear(the onset of paralysis)
 Impaired or altered sense of taste.
 Sensitivity to loud noise.
 drying of the eye on the affected side/eye watering.
 Difficulty with eating(involuntary drooling)
 Difficulty with speaking clearly( ‘B’ and ‘P’)
 Streaming nostril on the affected side.
HOW IS BELL’S PALSY DIAGNOSED?

 Diagnosis of Bell’s palsy is made by exclusion.

 Neurological examination.

 Bell’s palsy :
 rapid loss of the ability to move the affected side.

 facial movement is severely impaired

 no other symptoms or signs.

 Blood tests:
 Lyme disease 

 Ramsay Hunt syndrome.

 MRI/CT scan

 Test ENT

 Electromyography (EMG)
WHAT IS THE INITIAL TREATMENT FOR BELL’S PALSY?

 Steroids and antiviral (within 72 hours)

 Prednisolone (steroid).

 Aciclovir (antiviral drug)

 Ramsay Hunt syndrome ;rash or blisters in or around the ear, scalp, hair line,

mouth.

 Eye care etc

 Exercise not recommended

 Recent studies show that antiviral do not improve the outcome.

 Some patients will not recover fully.

TREATMENT FOR PROLONGED/PERMANENT BELL’S
PALSY

 If full recovery is not obtained within three months.

 Treatments include:
 Physiotherapist/speech and language therapist for facial
rehabilitation therapy

 Botulinum toxin injections (aim is to reduce

overactivity).
 After a minimum of two years some surgical procedures
may be required
WHAT IS THE PROGNOSIS OF BELL’S PALSY?

 length of time (dependent on the initial damage)

 over 70 % full recovery(as early as 2-3 weeks/ 3-6 months and beyond)

 20-30 % of cases will have ongoing symptoms.

 Severe nerve damage is more likely to occur if the patient

 Is over 60;
 Had severe pain at onset;
 Had complete rather than partial paralysis at onset;
 Had a preexisting health condition such as diabetes or high blood pressure;
 Was pregnant at the time of onset;
 If recovery had not begun after six weeks.
  complete rather than partial paralysis at onset;

 diabetes or high blood pressure;

 pregnant at the time of onset;

 If recovery had not begun after six weeks.

 7% have recurrent Bell’s palsy, with the average interval between

attacks being ten years.

 Newer and more advanced treatments ,

 assist;severe nerve damage,

 expressiveness, facial function and appearance.

WHAT ARE THE POSSIBLE COMPLICATIONS OF
BELL’S PALSY?

 Complexity of facial muscles(more complications)

 Contracture

 Crocodile tears: (during eating; faulty ‘re-wiring’ of the nerves during the

recovery phase)

 Lagophthalmos (eye dryness / corneal ulceration;tear drops).

 Synkinesis (intentionally trying to move one part of the face, another part

moves automatically)

 Persistent symptoms
 psychological;stress, anxiety,depression &

 low self-esteem