-A brief Description about the bell's palsy including: causes the signs and symptoms and the proper treatment. -All the information present from reliable sources(Text books and articles). Done by: Abdulelah Alshammri, second year dental student.

1. Abdulelah Alshammri
BDS student
Aljouf-Saudi Arabia

2. Contents
• Brief review about facial nerve.
• Definition of bell’s palsy.
• Etiology.
• Pathogenesis.
• Diagnosis.
• Epidemiology of the disorder.
• Clinical features.
• Treatment.
• Conclusion.
• References.
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3. Facial Nerve
Origin: at the junction of pons and medulla oblongata.
Course: pass through external acoustic meatus and leave
the cranial cavity, then stylomastoid foramina, terminate
by fusing of the two roots in the temporal bone.
Functions
Sensory
• External acoustic meatus and
auricle.
• Taste sensation of anterior 2/3 of
the tongue.
Motor
• Innervate lacrimal gland , sub-lingual, sub-
mandibular gland.
• Innervate facial , scalp muscles.
• Innervate stapedius , post.belly of digastric
muscle, stylohyoid muscle.

4. Facial Nerve

5. BELL’S PALSY

6. Definition
• an abrupt, unilateral, isolated facial nerve paralysis.
• one of the most common neurological disorder of
the cranial nerves.
There’s no detectable cause for such a disorder…

7. Etiology
The disorder is considered - Idiopathic origin
However, it’s found to be strongly associated with:
• Herpes simplex virus(HSV).
• Herpes zoster.
• Diabetic patient.
• Pregnancy.
• Epstein-Barr virus.
• Hereditary factor may play a role.

8. Pathogenesis
*Unknown yet!
• But a popular theory propose that reactivation of
herpes simplex virus cause inflammation, ischemia and
demyelination of facial nerve, which can alter the
sensory and motor function of the facial nerve.
• An increased incidence of Bell’s palsy was also reported
among recipients of inactivated intranasal influenza
vaccine.

9. Diagnosis
The diagnosis of such a disorder is purely clinical
1. Electrodignostic testing: done in 14 days , provide
information about the prognosis.

10. Diagnosis
2. Nerve excitability test: determines the excitation
threshold by recording the minimum electrical stimulus
required to produce visible muscle contraction, and
compare the action potential between the affected side
and the healthy one.
3. Trigeminal blink reflex: measure intracranial
pathway of the facial nerve and also useful test to
study various post-paralysis sequelae such as
synkinesis and hemifacial spasms

11. Epidemiology
• Bell’s palsy, one of the most common facial disorder,
affects both men and women.
• Common in age between 10-40 years.
• The great occurrence has been noted in Japan, Mexico and
Israel, however the incidence varies in different parts of
the world.
In Al-Jouf region:
• Regarding the seasonal onset, the disease incidence are
more during autumn season followed by winter season.
• The disease are more common between the ages10-30 in
Al-Jouf.
Shahid Jamil, Khalid Hassan Khan, Shahnaz Nadir, Hamud A. Alsaad: Seasonal Incidence of Bell’s Palsy In
Al-jouf Region, J. Med. Sci. April 2013, Vol. 21, No. 2: 99-101.

12. Clinical features
Inability to
express
normal facial
expression
Impaired taste
sensation on
anterior portion
of the tongue
Pain on the side
of the face
Aching Pain in or
around the ear precede
the onset.

13. Clinical features

14. Treatment
There’s no specific treatment for bell’s palsy
• Corticosteroids
• Antiviral agents
• Physical Therapy: various physical therapies such as
exercise, biofeedback, laser, electrotherapy, massage and
thermotherapy
• Eye care includes eye patching and lubrication
• Surgical treatment

15. Prognosis
Studies showed that about more than two thirds of patients
with Bell's palsy achieve full spontaneous recovery
• In 85% of people show improvement within 3 weeks of
onset.
• For the other 15%, some improvement occurred 3 to 6
months later
• And in the same patients 71% of them recover the normal
facial function and appearance

16. Conclusion
• So, until now there’s no absolute etiology for bell’s palsy.
• Clinical presentation varies, may be partial or complete
palsy.
• Regarding the prognosis, bell’s palsy shows great number
of patient’s recovery, most of them within 3 weeks.
• Restoring the normal facial appearance varies. However
most of cases show full facial appearance recovery.
• The treatment is not specific, but as mentioned some
treatment found to be effective.

17. References
• Gray’s anatomy for student by Richard L. Drake , A. Wayne Vogl , Adam
W.M.Mitchell , 3rd ed, Chapter 8; Pg.894-9.
• Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo
J. eds.Harrison's Principles of Internal Medicine, 19ed New York, NY:
McGraw-Hill, 2014.
• Shafer,Hinem Levy. Shafer’s Text book of Oral Pathology, 7th Ed; Chapter
20, Pg. 857-75.
• Shahid Jamil, Khalid Hassan Khan, Shahnaz Nadir, Hamud A. Alsaad:
Seasonal Incidence Of Bell’s Palsy In Al-jouf Region, J. Med. Sci.
(Peshawar, Print) April 2013, Vol. 21(2): 99-101.
• Murthy JM, Saxena AB. Bell's palsy: Treatment guidelines. Ann Indian
Acad Neurol. 2011;14:S70–2.