Bells palsy

2,877 views
2,859 views

Published on

Published in: Health & Medicine
0 Comments
9 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,877
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
406
Comments
0
Likes
9
Embeds 0
No embeds

No notes for slide

Bells palsy

  1. 1. Bell’s Palsy: PRESENTED BY- DR NANDANI KUMARI PG II YEAR 10/7/2013 1BELLS PALSY
  2. 2. 10/7/2013 2BELLS PALSY
  3. 3. 10/7/2013 3BELLS PALSY
  4. 4. Submandibular ganglion Submandibular gland 10/7/2013 4BELLS PALSY
  5. 5. 10/7/2013 5BELLS PALSY
  6. 6. Bell’s Palsy Defined It is an idiopathic paralysis of the facial nerve of sudden onset. Unilateral lower motor neuron paralysis of sudden onset,not related to any other disease elsewhere in the body. 10/7/2013 6BELLS PALSY
  7. 7. Who is Bell ?  Charles Bell  known for his studies on the nervous system and the brain.  In the 19th century discovered that lesions of the 7th cranial nerve causes facial paralysis. 10/7/2013 7BELLS PALSY
  8. 8. Facial Nerve Each nerve controls:  Eye blinking and closing  Facial expressions  Smiling and frowning  Tear glands  Saliva glands  Muscle of small bone in middle of ear called the stapes  Taste sensations 10/7/2013 8BELLS PALSY
  9. 9. Cause  Unknown cause  Evidence shows that reactivated herpes simplex virus (HSV) may be involved in some cases.  Reactivation of the HSV causes inflammation, edema, ischemia, and eventual demyelination of the facial nerve, causing pain and alterations in motor and sensory function. 10/7/2013 9BELLS PALSY
  10. 10.  May be caused by a viral infection  Viral meningitis  Herpes simplex  Headaches  Chronic ear infections  High blood pressure  Diabetes  Sarcoidosis  Tumors  Lyme disease  trauma 10/7/2013 10BELLS PALSY
  11. 11.  Because it's swollen, the nerve gets compressed as it passes through a small hole at the base of the skull, which causes the symptoms of Bell's palsy.  Bell's palsy can affect people of all ages, but it is most common in adults.  People with diabetes and pregnant women are more likely to develop Bell's palsy. 10/7/2013 11BELLS PALSY
  12. 12. Examination  Differentiate between upper and lower motor neurone lesion  UML: frontalis is spared allowing normal furrowing of brow and eye blinking  LML: all muscles of facial expression are affected 10/7/2013 12BELLS PALSY
  13. 13. 10/7/2013 13BELLS PALSY
  14. 14. Evaluation  Careful history – timing  Associated symptoms  recurrent  Physical exam  CT/MRI  Electrophysiology 14 10/7/2013 BELLS PALSY
  15. 15. S/S  Varies from person to person  Comes on suddenly  Mild to total paralysis  Weakness, twitching on one of both sides of the face  Facial and eyelid droop  Drooling  Dryness of eye or mouth  Impairment of taste  Excessive tearing of eye 10/7/2013 15BELLS PALSY
  16. 16.  Pain behind the ear may precede the paralysis by a day or two .  Impairement of taste is present to some degree in all cases –rarely beyond second week of paralysis.  Hyperacusis or distortion of sound in ipsilateral ear ---paralysis of stapedius muscle. 10/7/2013 16BELLS PALSY
  17. 17.  Patient feels stiffness of face pulled to one side.  Ipsilateral restriction of eye closure, difficulty with eating ,fine facial movements.  Disturbance of taste –chorda tympani fibres  Hyperacusis—fibers to stapedius 10/7/2013 17BELLS PALSY
  18. 18. BELL’S PHENOMENON  Normally on closing the eye ,the eyeball moves upwards and inwards.  This is on the affected side due to ineffective closure of the eyelids. 10/7/2013 18BELLS PALSY
  19. 19. Clinically  Corner of mouth droops  Skin folds effaces  Forehead is unfurrowed  Eyelids will not close  Eye on the paralysed side rolls upward – BELL’S PHENOMENON  Lower lid sags and falls away from conjunctiva  Tearing.  Saliva may dribble from the corner of the mouth  Heaviness or numbeness of the face10/7/2013 19BELLS PALSY
  20. 20. House-Brackmann grading system  Grade I - Normal  Grade II - Mild dysfunction, slight weakness on close inspection, normal symmetry at rest  Grade III - Moderate dysfunction, obvious but not disfiguring difference between sides, eye can be completely closed with effort  Grade IV - Moderately severe, normal tone at rest, obvious weakness or asymmetry with movement, incomplete closure of eye  Grade V - Severe dysfunction, only barely perceptible motion, asymmetry at rest  Grade VI - No movement 10/7/2013 20BELLS PALSY
  21. 21. Diagnosed  There are no specific lab tests to confirm diagnosis  Will exam for upper and lower facial weakness  Electromyography  Confirm presence of damage and determine severity  MRI and CT  causes of pressure on nerve 10/7/2013 21BELLS PALSY
  22. 22. Differential diagnosis  Stroke  Herpes zooster virus  Lyme disease 10/7/2013 BELLS PALSY 22
  23. 23. Prognosis  80% patients recover within a few weeks.2-12 weeks.  10%--permanent disfigurement.long term sequelae.  8%--recurrence  Best clinical guide to progress is the severity of the palsy during the first few days after presentation.  Recovery of taste precedes motor function. 10/7/2013 23BELLS PALSY
  24. 24.  If recovery of taste occurs in first week –good prognostic sign.  Early recovery of motor function in the first 5- 7 days— most favourable prognosis.  Recurrence is due to reactivation of virus,pregnancy.  Interval between periods is not predictable. 10/7/2013 24BELLS PALSY
  25. 25. Treatment  Controversial  Symptomatic  Protection of eye during the sleep -patch  Massage of the weakened muscles  Lubricating eye drops  Prednisolone 60-80 mg/day in divided doses intial 4-5 days,then taper over next 7-10 days.  Decreases the possibility of permanent paralysis  From swelling of facial nerve in facial canal.  Decreases the severe pain. 10/7/2013 25BELLS PALSY
  26. 26. Medical treatment  Acyclovir 400 mg 5 times/day  Famciclovir and valacyclovir 500 mg bid 10/7/2013 26BELLS PALSY
  27. 27. Surgical treatment  Facial nerve decompression  Indication  Completely paralysis  Appropriate time for surgery is 2-3 weeks after paralysis. 10/7/2013 27BELLS PALSY
  28. 28. Electrophysiology  Treatment plan based on 16% of patients who do not fully recover  Several tests used for prognosis  Measure amounts of neural degeneration occurred distal to injury by measuring muscle response to electrical stimulus  Able to differentiate nerve fibers undergoing Wallerian degeneration. 2810/7/2013 BELLS PALSY
  29. 29. Temporal bone fractures  Signs  bleeding from the external canal  hemotympanum  step-deformity of the osseous canal  conductive hearing loss (longitudinal fracture)  sensorineural hearing loss (transverse fracture)  CSF otorrhea  facial nerve involvement (20% of longitudinal fractures and 50% of transverse fractures) 10/7/2013 29BELLS PALSY
  30. 30. Longitudinal VS Transverse Type of injury Longitudinal Transverse Incidence 70-90% 10-20% Site of injury Temporal , Parietal area Occipital , Frontal area 10/7/2013 30BELLS PALSY
  31. 31. Sequelae  Long delay in the onset of recovery—3months  Regeneration of nerve –2 years  Incomplete  Crocodile tears  Facial spasms 10/7/2013 31BELLS PALSY
  32. 32. That’s interesting…  Famous people that have had Bell’s palsy  Roseanne Barr, American actress and comedian  Stevie Benton, Bassist for Texas rock band, Drowning Pool  Pierce Brosnan, Irish actor and producer  George Clooney, American actor, director, producer and screenwriter  Alexis Denisof, Actor  Graeme Garden, British comedy writer and performer, who has written about his experiences with the condition  Tony Gonzalez, American NFL football player  Jane Greer, actress, had when 15 y/o 10/7/2013 32BELLS PALSY
  33. 33. The list goes on  Katie Holmes, Actress  Ralph Kiner, American baseball player in the 1940s and 1950s  Amy Goodman, American journalist and author  Curtis LeMay, was a general in the United States Air Force and the vice presidential running mate of independent candidate George C. Wallace in 1968  Ralph Nader, American author, activist, politician  Jim Ross, professional wrestling announcer for WWE RAW  Rick Savage, British musician and bassist for Def Leppard  Jamey Sheridan, American actor. His condition was written into the show Law and Order: Criminal Intent and his character Captain James Deakins also had Bell's palsy.  Joseph C. Wilson, American diplomat  Milo Ventimiglia, Actor 10/7/2013 33BELLS PALSY
  34. 34. THANKS 10/7/2013 34dr nandani IDS BAREILLY
  35. 35. 10/7/2013 BELLS PALSY 35

×