Bell’s palsy (facial paralysis)is caused by unilateral inflammation of the seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side. Bell s palsy is a type of pressure paralysis. The inflamed edematous nerve becomes compressed to the point of damage or the blood supply is occluded, producing ischemic necrosis of the nerve. It affects the facial nerve the seventh cranial nerve.It affects men and women in the same incidence rate
- The cause is unknown.
- Vascular ischemia, viral disease(herpes zoster, Herpes simplex),autoimmune disease or a combination of all these factors.
- The face is distorted from paralysis of the facial muscles.
- Increased lacrimation.
- Painful sensation of the face behind the ear and in the eye.
- Speech difficulties and inability to eat on the affected side due to the weakness or paralysis of the facial muscles.
- The objective of the treatment is to maintain the muscle tone of the face and to prevent or minimize denervation.
- Patient should be reassured that the recovery occurs within 3to5 weeks in most of the patients.
- Corticosteroid therapy(Prednisone)is prescribed to reduce inflammation sand to prevent edema. It reduces vascular compression and permits restoration of the blood supply to the nerve. Early administration of the corticosteroid therapy appears to diminish the severity of the disease., relieving the pain and prevent denervation.
- Facial pain is relieved by analgesic agents,hot may be applied to the involved side of the face to prevent muscle atrophy.
- Electrical stimulation is applied to the face to prevent muscle atrophy.
- Surgical exploration of the facial nerve is recommended if tumor is suspected.
- Protection of the eye from the injury.the eyes doesnot close completely and the blink reflex is diminished,so the eye is vulnerable to injury from dust and foreign particles.Corneal irritation and ulceration occurs.The eyes should be covered with eye shield.Eye ointment is applied on the eyelids at bedtime to promote adherence of the eyelids and and to prevent injury during the sleep.The patient should be taught to manually close the eyes before going to sleep.Wrap around sun glasses or googles is worn during the daytime to decrease the evaporation from the eye.
- Suggest massaging the face several times dailyusing a gentle upward motion to maintain muscle tone.
- Facial exercises such as wrinkling of the forehead,blowing out of the cheeks and whistling may be performed with the aid of a mirror to prevent muscle atrophy.
- Exposure of the face to cold is avoided.