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dr jignesh vora

dr jignesh vora



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Bell’palsy Bell’palsy Presentation Transcript

  • The facial nerve controls the muscles on the side of the face It allows us to show expression, smile, cry, and wink Injury to the facial nerve can cause a socially and psychologically devastating physical defect although most cases resolve spontaneously, treatment may ultimately require extensive rehabilitation The facial nerve is the seventh of the twelve cranial nerves Everyone has two facial nerves, one for each side of the face The facial nerve travels with the auditory nerve (the eighth cranial nerve) as it travels in and around the structures of the middle ear It exits the front of the ear at the stylomastoid foramen (a hole in the skull base), where it then travels through the parotid gland In the parotid gland it divides into many branches that provide motor function for the various muscles and glands of the head and neck.
  • facial muscle paralysis – weakness twitching of the face Dryness of the eye or the mouth alteration of taste on the affected side excessive tearing or salivation
  • Trauma - birth trauma, skull base fractures, facial injuries, middle ear injuries, or surgical trauma Nervous system disease - stroke Infection of the ear or face - herpes zoster of the facial nerve (Ramsay Hunt syndrome) Tumors - acoustic neuroma, parotid tumors Toxins - alcoholism , CO poisoning DM pregnancy
  • Hearing tests - assess the status of the auditory nerve. Balance tests - find out if part of the auditory nerve is involved. Tear tests - The loss of the ability to form tears may help to locate the site and severity of a facial nerve lesion. Taste tests - The loss of taste in the front of the tongue may help locate the site and severity of a facial nerve lesion. Salivation test - Decreased flow of saliva may help locate the site and severity of a facial nerve lesion. CT / MRI - tumor, a bone fracture Electrical nerve stimulation
  • Bell's palsy is paralysis of the facial nerve of unknown cause Bell's palsy is usually a self-limiting, non- life-threatening condition that resolves spontaneously, usually within six weeks The incidence is 15 to 30 new cases per 100,000 people per year
  • Acute unilateral paralysis of facial muscles is present; the paralysis involves all muscles, including the forehead. numbness or pain in the ear, face, neck or tongue. There is a preceding viral illness in 60% of patients.
  • Primary viral infection (herpes) sometime in the past. The virus lives in the nerve (ganglion) from months to years. The virus becomes reactivated at a later date. The virus reproduces and travels along the nerve. The virus infects the cells surrounding the nerve (Schwann cells) resulting in inflammation. The immune system responds to the damaged Schwann cells, which causes inflammation of the nerve and subsequent weakness or paralysis of the face.
  • prednisone - for 7 to 14 days acyclovir with steroids increase recovery physical therapy electrotherapy
  • protective glasses manual closure of the eye with a finger ointments to keep the eye lubricated patching the eye closed
  • Nerve repair or nerve grafts: Facial nerve regeneration occurs at a rate of one millimeter per day. If a nerve has been cut or removed, direct microscopic repair is the best option. Nerve transposition: Often the tongue nerve (hypoglossal nerve) or the other facial nerve can be connected to the existing facial nerve. For example, the patient can then train themselves to move their face by moving their tongue. Muscle transposition or sling procedures: The temporalis muscle or masseter muscle (some of the only muscles on the face not supplied by the facial nerve), can be moved down and connected to the corner of the mouth to allow movement of the face. Muscle transfers: Free muscles from the leg (gracilis) can be used to provide both muscle bulk and function. Often a cross facial nerve transposition is done to provide similar nerve supply to the donor muscle flap. Ancillary eyelid or oral procedures: In addition to one of the above, often it is necessary to include a brow lift or facelift, partial lip resection, eyelid repositioning, lower eyelid shortening, upper eyelid weights, or eyelid springs in reconstructive surgery following severe facial nerve palsies.
  • depends on the underlying 70% of persons who experience Bell's palsy will have complete recovery best outcome with rapid Dx & Rx