Saturday, 29 October 2011

Bells Palsy

Bells palsy
It is also called as 7th nerve paralysis or facial paralysis.The whole face of same side gets paralysed. the face becomes asymmetrical and drawn up to normal side. The affected side is motionless.The patient is unable is close eyes and saliva keep drooling out of mouth. corners of mouth become dry.Bell's palsy was named after a Scottish doctor, Sir Charles Bell who studies about the facial nerve.one have one facial nerve on each side of face( left & right).These nerves send messages from the brain to the face. Through these messages, the facial nerves control the muscles of your face, forehead, and neck.Facial nerves control the expressions like raising your eyebrows, squeezing your eyes shut, or smiling. Each facial nerve starts in the brain, goes through the skull in a narrow tube of bone, and exits the skull behind the ear. From there, it splits into smaller branches of nerves that attach to the muscles of the face, neck, and ear. Other small nerve branches run to the glands that make saliva, the glands that make tears, and the front of the tongue..

Pathogenesis

# The cortical tract communicating with the motor nucleus ambiguous of facial nerve crosses over to get innervated in to the lower face musculature. upper face fibers are ipsilateral proximal to the nucleus.
# A cortical lesion will cause contralateral lower face palsy:lesions of brainstem, mainly trunk or peripheral fibers will result in total hemifacial paralysis.

Etiology

  • Cold-It usually occurs after exposure to cold. But many believe that it is a change finding.
  • Trauma-It may be a causative factor as it occurs after extraction of teeth and after injection of local anesthetic. it may cause damage to nerve & subsequent paralysis.
  • Surgical Procedure-After surgical procedure of removal of parotid gland tumor in which facial nerve is sectioned can also cause facial paralysis.
  • Ischemia-Ischemia of nerve near the stylomastoid foramen can result in edema of nerve, its compression in the bony canal and finally paralysis.
  • Familial-Familial & hereditary occurrence is also reported .
  • Facial canal & middle ear neoplasm
  • Tumors

Clinical features

  • 1Age & sex- women are more commonly affected.It occurs in middle age group.It arises more frequently in spring and falls than at any other time of the year.
  • 2Onset- It begins abruptly as paralysis of the facial musculature, usually unilaterally.
  • 3Prodromal symptoms- In some cases it is preceded by pain on the side of the face which is ultimately involved, particularly within the ear, temple, mastoid area or at the angle of the jaw.
  • 4Eye- on affected side eye can not be closed& wrinkles are absent on that side. there is watering eye, which lead to infection.
  • 5Syndrome assosiated- Melkersson-Rosenthal syndrome
  • 6when patient smiles, the paralysis becomes obvious since the corner of yhe mouth does not rise nor does the skin of the forehead wrinkles or the eyebrows raise.

Oral manifestations


  1. CORNER OF MOUTH- The muscular paralysis manifests itself by drooping of the corner of mouth from which saliva may dribble
  2. Appearance- the patient has atypical masklike or expressionless appearance. Speech & eating is difficult & occasionally, taste sensation on the anterior portion of tongue is lost or altered.
  3. Food is retained in the upper & lower buccal & labial fold due to weakness of buccinator.

Management

Treatment

  • The use of vasodilator drug like histamine
  • Administration of physiologic flushing dose of nicotinic acid
  • Surgical anastomosis of nerves has been carried out, especially with facial & hypoglossal nerve;thus can restore partial function.
  • Systemic Steroids or ACTH injections have been successful.
  • Eye drops for eyes & eyepads



Bells palsy

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