Neurolgy Chapter of IAP

Bell’s Palsy

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Neurolgy Chapter of IAP

Bell’s Palsy

• Characterized by:– Peripheral facial paralysis– Acute benign cranial polyneuritis

Acute disorder characterized by a disruption of the motor branches of cranial nerve VII on one side of the face. (in absence of stroke)

Neurolgy Chapter of IAP

Bell’s Palsy

• Can affect any age group, though more common from 20-60.

• Etiology unknown; though reactivated herpes simplex may be involved.

• Reactivation causes edema, inflammation, ischemia, and eventual demyelination of the nerve, creating pain and alteration in motor and sensory function.

Neurolgy Chapter of IAP

Clinical manifestations

• Benign, with 85% of people recovering in 6 months-remaining 15% have some asymmetry of facial muscles

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Neurolgy Chapter of IAP

Clinical manifestations

• Often accompanied by an outbreak of herpes vesicles in or around the ear.

• Pain around or behind the ear• Fever, tinnitus, hearing deficits• Flaccidity of the affected side of the face with

drooping of the mouth accompanied by drooling DT paralysis of the facial nerve (motor branches)

Neurolgy Chapter of IAP

Clinical manifestations

• Inability to close the eyelids, with an upward movement of the eyeball when closure is attempted; lower lid may turn out

• Wide palpebral fissure (opening between eyelids)• Flattening of the nasolabial fold• Inability to smile, frown, or whistle• Unilateral loss of taste• Altered chewing ability; loss of or excessive tearing

Neurolgy Chapter of IAP

Complications

• Psychological withdrawal DT changes in appearance,malnutrition or dehydration, mucous membrane trauma, corneal abrasion, muscle stretching, and facial spasms and contractures.

Neurolgy Chapter of IAP

Diagnostic Studies

• Diagnosis made on basis of symptoms in the absence of other causes of paralysis such as stroke.

• No definitive test

• EMG may determine nerve excitability or absence

Neurolgy Chapter of IAP

Therapeutic Management

• Corticosteroids- drug of choice• Prednisone may be started immediately!

– Best if initiated before paralysis is complete– Taper off over 2 weeks– Decrease edema and painAnalgesics may be needed for painAntivirals : Acyclovir (Zovirax) and Famvir because

HSV is implicated in 70% of cases.See Lewis 1719-1720- Nursing Implementation