Introduction of bell’s palsy..
Bell’s Palsy,It’s also known as “ Idiopathic Peripheral Facial Palsy”, considers an idiopathic condition, there’s No specific cause that has been conclusively established. Once other causes of facial palsy have been ruled out, then the patient is said to have “Bell’s Palsy”.
It’s one of the most common causes of acute unilateral facial paralysis, “60 and 70%” of all unilateral facial palsy cases.
Definition:
Its peripheral palsy of the facial nerve “LMN”, results from dysfunction of the peripheral CN VII, it involves weakness or paralysis, typically one side of the face.
- Begin suddenly and worsen over 48 hours.
- Onset is rapid.
Temporary inability to control facial muscles on the affected side.
CN VII “ facial nerve” Innervate:
- Muscles of the face.
- Lacrimal gland.
- Sublingual gland.
- Submandibular gland.
- Mucous membrane of nose.
- Mouth, nasopharynx.
- Stapedius muscle.
- Sensory information about taste. “ Anterior ⅔. of tongue.
Pathological process:
The facial nerve is damaged by inflammation within the nerve, causing it to enlarge, at the point where the nerve exits the skull through stylomastoid foramen.
Inflammation or damage to the lower motor neurons.
- inflammation from both contralateral and ipsilateral motor cortex lost for the upper face.
- Inflammation from contralateral motor cortex lost in lower face.
- Paralysis of all muscles on the ipsilateral side.
Signs and Symptoms of Bell’s palsy:
- Weakness on one side of the face. Weakness may be partial or complete on one side of the face.
- No wrinkles in the forehead.
- Dropping in the eyelid.
- Dropping one side of the mouth.
- Drooling.
- Inability to completely close the eye.
- Tearing and pain in the eye.
- Facial pain.
- Loss of taste.
- Hypersensitivity to the sounds.
Causes of Bell’s palsy:
- Main cause is unknown.
- Viral origin. “ herpes complex virus.“ common cause.
- Reduced blood supply to the facial nerve.
- Inflammation of facial nerve.
- Motor cortex disorder. “LMNL”
Risk factors:
- History of viral or bacterial infection.
- Sarcoidosis.
- Diabetes mellitus. DM
- Pregnancy.
- Hypertension. HTN
Complications:
- Abnormal growth of facial nerve fibers.
- Permanent damage to the facial nerve.
- Visual loss due to corneal dryness.
Diagnosis:
- Patient history and physical examination.
- Brain imaging. CT scan, MRI.
Differential diagnosis:
- Brain tumor.
- Myasthenia gravis.
- CNS neoplasms.
- Stroke.
- HIV infection.
- Multiple sclerosis.
- Guillain_Barre syndrome.
- Ramsay-Hunt syndrome.
- Melkersson-Rosenthal syndrome.
- Lyme disease.
- Trauma to the facial nerve.
Treatment and Management:
** Spontaneous resolving:
- Most patients (70%) recover completely within 3 to 4 months without any medications.
- Less commonly, symptoms stay and never disappear.
** Anti inflammatory medication “Corticosteroid”.
** Physiotherapy management:
- Promote facial muscle control and coordination.
- Refine the facial movements for specific functions, such as “ speaking or closing the eye, by strengthening exercises.
- Refine the facial expressions movements, like smiling.
- Facilitation exercise.
- Correct the abnormal patterns of the facial movement which can occur during recovery.
- Patient education and advice.
- Low Laser therapy.
- Massage: facial sensation is still intact, so massage within pain tolerance level is important intervention with Bell’s palsy patients, which keep flaccid muscles elastic and well nourished.
- Electric stimulation (ES): may prevent muscle atrophy and promote tissue healing, and therefore it may help to prevent consequences of Bell’s palsy, but due to lack of high quality studies in using ES, “ many studies don’t support it” , the effectiveness of ES in Bell’s palsy is still controversial.
-
is electrical stimulation good for bell’s palsy?
Some studies show that:
“No papers were found that involved ES usage in physiotherapy treatment of Bell’s palsy in the acute setting”.
There is NO evidence to suggest that either exercises or electrical stimulation is beneficial to patients with acute Bell’s palsy
References:
- R;, G. (n.d.). Pathogenesis of Bell’s Palsy. retrograde epineurial edema and postedematous fibrous compression neuropathy of the facial nerve. The Annals of otology, rhinology, and laryngology. Retrieved January 23, 2023, from https://pubmed.ncbi.nlm.nih.gov/889228/
- VanSwearingen, J. M. (2017, September 21). GUIDE: Physical therapy guide to Bell’s Palsy. Choose PT. Retrieved January 23, 2023, from https://www.choosept.com/guide/physical-therapy-guide-bells-palsy
- Buttress, S. (2002). Electrical stimulation and Bell’s Palsy. Emergency Medicine Journal, 19(5). https://doi.org/10.1136/emj.19.5.428-a
- Loyo, M., McReynold, M., Mace, J. C., & Cameron, M. (2020). Protocol for randomized controlled trial of electric stimulation with high-volt twin peak versus placebo for facial functional recovery from Acute Bell’s palsy in patients with poor prognostic factors. Journal of Rehabilitation and Assistive Technologies Engineering, 7, 205566832096414. https://doi.org/10.1177/2055668320964142
