Bell's Palsy J van Wyk

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Bell's Palsy J van Wyk

  1. 1. BELL’S PALSY BELL'S PALSY IS A FORM OF FACIAL PARALYSIS RESULTING FROM A DYSFUNCTION OF THE CRANIAL NERVE VII (THE FACIAL NERVE) CAUSING AN INABILITY TO CONTROL FACIAL MUSCLES ON THE AFFECTED SIDE 7/19/2014Jacqui van Wyk Therapeutic Health Options 1
  2. 2. SIR CHARLES BELL (12 NOVEMBER 1774 – 28 APRIL 1842) A SCOTT NOTED FOR DISCOVERING THE DIFFERENCE BETWEEN SENSORY NERVES AND MOTOR NERVES IN THE SPINAL CORD AND FOR DESCRIBING BELL'S PALSY. 7/19/2014Jacqui van Wyk Therapeutic Health Options 2
  3. 3. 12 CRANIAL NERVES 7/19/2014Jacqui van Wyk Therapeutic Health Options 3
  4. 4. Bell's palsy is the most common cause of acute facial nerve paralysis. There is no known cause of Bell's palsy, although it has been associated with herpes simplex infection. Bell's Palsy may develop over several days, and may last several months, in the majority of cases recovering spontaneously. It is typically diagnosed clinically, in patients with no risk factors for other causes, without vesicles in the ear, and with no other neurological signs. Recovery may be delayed in the elderly, or those with a complete paralysis. Bell's palsy is often treated with corticosteroids. BELL’S PALSY 7/19/2014Jacqui van Wyk Therapeutic Health Options 4
  5. 5. BELL’S PALSY AFFECTS THE FACIAL NERVES CONTROL A NUMBER OF FUNCTIONS, SUCH AS BLINKING AND CLOSING THE EYES, SMILING, FROWNING, LACRIMATION, SALIVATION, FLARING NOSTRILS AND RAISING EYEBROWS. THEY ALSO INNERVATE THE STAPEDIAL (STAPES) MUSCLES OF THE MIDDLE EAR AND CARRY TASTE SENSATIONS FROM THE ANTERIOR TWO-THIRDS OF THE TONGUE. BECAUSE BOTH THE NERVE TO THE STAPEDIUS AND THE CHORDA TYMPANI NERVE (TASTE) ARE BRANCHES OF THE FACIAL NERVE, PATIENTS WITH BELL'S PALSY MAY PRESENT WITH HYPERACUSIS OR LOSS OF TASTE SENSATION IN THE ANTERIOR 2/3 OF THE TONGUE. THE FOREHEAD MUSCLES ARE USUALLY AFFECTED. • ALTHOUGH DEFINED AS A MONONEURITIS (INVOLVING ONLY ONE NERVE), PATIENTS DIAGNOSED WITH BELL’S PALSY MAY HAVE "MYRIAD NEUROLOGICAL SYMPTOMS" INCLUDING "FACIAL TINGLING, MODERATE OR SEVERE HEADACHE/NECK PAIN, MEMORY PROBLEMS, BALANCE PROBLEMS, IPSILATERAL LIMB PARESTHESIAS, IPSILATERAL LIMB WEAKNESS, AND A SENSE OF CLUMSINESS" THAT ARE "UNEXPLAINED BY FACIAL NERVE DYSFUNCTION". • BELL'S PALSY IS A DIAGNOSIS OF EXCLUSION, MEANING IT IS DIAGNOSED BY ELIMINATION OF OTHER REASONABLE POSSIBILITIES. BY DEFINITION, NO SPECIFIC CAUSE CAN BE DETERMINED. THERE ARE NO ROUTINE LAB OR IMAGING TESTS REQUIRED TO MAKE THE DIAGNOSIS THE DEGREE OF NERVE DAMAGE CAN BE ASSESSED USING THE HOUSE-BRACKMANN SCORE. 7/19/2014Jacqui van Wyk Therapeutic Health Options 5
  6. 6. TEST THEY USE TO DETERMINE THE GRADE OF BELL’S PALSY HOUSE-BRACKMANN SCORE 7/19/2014Jacqui van Wyk Therapeutic Health Options 6
  7. 7. AN INFLAMMATORY CONDITION LEADS TO SWELLING OF THE FACIAL NERVE. THE NERVE TRAVELS THROUGH THE SKULL IN A NARROW BONE CANAL BENEATH THE EAR. NERVE SWELLING AND COMPRESSION IN THE NARROW BONE CANAL ARE THOUGHT TO LEAD TO NERVE INHIBITION, DAMAGE OR DEATH. NERVE AFFECTED BY BELL’S PALSY FACIAL NERVE CNVII 7/19/2014Jacqui van Wyk Therapeutic Health Options 7
  8. 8. WHEN THE FACIAL NERVE IS WORKING PROPERLY, IT CARRIES A HOST OF MESSAGES FROM THE BRAIN TO THE FACE. THESE MESSAGES MAY TELL AN EYELID TO CLOSE, ONE SIDE OF THE MOUTH TO SMILE OR FROWN, SALIVARY GLANDS TO MAKE SPIT. FACIAL NERVES ALSO HELP OUR BODIES MAKE TEARS AND TASTE FAVOURITE FOODS. BUT IF THE NERVE SWELLS AND IS COMPRESSED, AS HAPPENS WITH BELL'S PALSY, THESE MESSAGES DON'T GET SENT CORRECTLY. THE RESULT IS WEAKNESS OR TEMPORARY PARALYSIS OF THE MUSCLES ON ONE SIDE OF THE FACE. EXPLAINING THE BRAIN AND FACIAL NERVE IMPLICATION 7/19/2014Jacqui van Wyk Therapeutic Health Options 8
  9. 9. The facial nerve carries axons of type GSA, general somatic afferent, to skin of the posterior ear. The facial nerve also carries axons of type GVE, general visceral efferent, which innervate the sublingual, submandibular, and lacrimal glands, also mucosa of nasal cavity. The facial nerve also carries axons of type SVE, special branchial-motor efferent, which innervate muscles of facial expression, stapedius, the posterior belly of digastric, and the stylohyoid. The facial nerve also carries axons of type SVA, special visceral afferent, which provide taste to anterior two-thirds of tongue via chorda tympani The facial nerve also carries axons of type GVA, general visceral afferent, which provide sensation to the soft palate and parts of the nasal cavity. THE MEDICAL TERMS 7/19/2014Jacqui van Wyk Therapeutic Health Options 9
  10. 10. CORTICOSTEROIDS HAVE BEEN FOUND TO IMPROVE BELL’S PALSY, WHEN USED EARLY, WHILE ANTI-VIRAL DRUGS HAVE NOT. OFTEN THE EYE ON THE AFFECTED SIDE CANNOT BE CLOSED. THE EYE MUST BE PROTECTED FROM DRYING OUT, OR THE CORNEA MAY BE PERMANENTLY DAMAGED RESULTING IN IMPAIRED VISION. IN SOME CASES DENTURE WEARERS EXPERIENCE SOME DISCOMFORT Facial nerve: the facial nerve's nuclei are in the brainstem (they are represented in the diagram. Orange: nerves coming from the left hemisphere of the brain. Yellow: nerves coming from the right hemisphere of the brain. Note: the forehead muscles receive innervation from both hemispheres of the brain (represented in yellow and orange). TREATMENT FOR BELL’S PALSY 7/19/2014Jacqui van Wyk Therapeutic Health Options 10
  11. 11. HOW DOES THE FACIAL NERVE INNERVATE THE FACE Cortical innervation is bilateral to portions of the forehead. Cortical innervation to the lower facial muscles is unilateral and contralateral. After a Cortical or corticonuclear lesion, forehead function may remain but lower facial muscles on CONTRALATERAL SIDE do not remain Facial nerve lesioned as in bells palsy all facial movement on affected side is lost 7/19/2014Jacqui van Wyk Therapeutic Health Options 11
  12. 12. FACIAL NERVE 7/19/2014Jacqui van Wyk Therapeutic Health Options 12
  13. 13. I WOULD LIKE TO EXPLAIN OUR PERSONAL EXPERIENCE WITH BELL’S PALSY • DIAGNOSED ON 10 FEBRUARY 2014 • MEDICATION FROM THE DOCTOR, PHYSIOTHERAPY WITH ELECTRONIC EQUIPMENT, THERAPEUTIC REFLEXOLOGY AND SHIATSU THERAPY • THIS IS A COMPLETELY DIFFERENT WAY TO HOW SCIENTIST THINK • THERAPEUTIC REFLEXOLOGY WAS STARTED 4TH MARCH 2014 • THERAPEUTIC REFLEXOLOGY WAS DONE ON THE PATIENT WITH BELL’S PALSY TWICE A WEEK 7/19/2014Jacqui van Wyk Therapeutic Health Options 13
  14. 14. RIANA THEDVALL Name: Riana Thedvall Age: 39 years Occupation: Project Manager Diagnosed with Bell’s Palsy: 10 February 2014 Severity: Grade 6 7/19/2014Jacqui van Wyk Therapeutic Health Options 14
  15. 15. I WOULD LIKE TO INTRODUCE YOU TO RIANA A PATIENT AND FRIEND • AS YOU ALL PROBABLY KNOW BY NOW, I DECIDED TO DO MY PROJECT ON BELL’S PALSY. • SATURDAY MORNING 08 FEBRUARY 2014 RIANA STARTED WITH TERRIBLE NECK PAIN (TRAPEZIUS MUSCLE) • SUNDAY 09 FEBRUARY 2014 SHE WENT AND LAY DOWN FOR A FEW HOURS DUE TO THE NECK PAIN, ON WAKING UP AROUND 6PM HER LEFT EYE BEGAN TO TEAR A LOT • AROUND 10PM SHE FELT HER MOUTH PULL TO ONE SIDE • THE NEXT MORNING (PICTURE TELLS THE STORY) This photograph was taken 3 days later in hospital on13 February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 15
  16. 16. SAW THE DOCTOR MONDAY 10 FEBRUARY2014 DOCTOR REFERRED HER TO A NEUROLOGIST, NEUROLOGIST ADMITTED HER TO HOSPITAL MEDICATION GIVEN INTRAVENOUSLY UNKNOWN PRESCRIPTION TO TAKE HOME: DORMONOCT 2MG (SHORT-TERM TREATMENT OF INSOMNIA) SLEEP DISTURBANCES IN THE GERIATRIC PATIENT. PRE-OPERATIVE SLEEP DISTURBANCES. DORMONOCT IS ONLY INDICATED WHEN THE DISORDER IS SEVERE, DISABLING OR SUBJECTING THE INDIVIDUAL TO EXTREME STRESS. ADCO-ALZAN 0.25MG ALZAM (ALPRAZOLAM) IS INDICATED FOR THE TREATMENT OF ANXIETY DISORDERS, OR THE SHORT-TERM RELIEF OF SYMPTOMS OF ANXIETY. ANXIETY ASSOCIATED WITH DEPRESSION IS RESPONSIVE TO ALZAM. ALZAM IS ALSO INDICATED FOR THE TREATMENT OF PANIC DISORDERS FOR UP TO EIGHT MONTHS. THE DOCTOR SHOULD PERIODICALLY RE-ASSESS THE USEFULNESS OF ALZAM (ALPRAZOLAM) IN THE TREATMENT OF ANXIETY DISORDERS; ANXIETY ASSOCIATED WITH DEPRESSION, FOR LONG TERM USE EXCEEDING SIX MONTHS HAS NOT BEEN ESTABLISHED. ALZAM IS ONLY INDICATED WHEN THE DISORDER IS SEVERE, DISABLING OR SUBJECTING THE INDIVIDUALS TO EXTREME STRESS.) TRIPLINE 25MG (STILL ON THE CHILL MEDS) AMITRIPTYLINE IS AN TRICYCLIC ANTIDEPRESSANT USED IN THE TREATMENT OF PATIENTS WITH ENDOGENOUS DEPRESSION. IT ALSO POSSESSES MILD TRANQUILLISING AND SEDATIVE PROPERTIES WHICH IS HELPFUL IN ALLEVIATING ANXIETY OR AGITATION THAT OFTEN ACCOMPANIES DEPRESSION. IT HAS BEEN USED WITH BENEFIT IN DEPRESSION OF LONG OR SHORT DURATION. ALL PATIENTS DO NOT RESPOND TO THE SAME DEGREE. SOME MAY RESPOND IN 4 TO 10 DAYS WHILE OTHERS MAY REQUIRE UP TO 30 DAYS TO OBTAIN BENEFIT. LACK OF RESPONSE MAY OCCUR OCCASIONALLY. Photograph taken on 17 February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 16
  17. 17. MEDICATION WAS GIVEN FOR 10 MORE DAYS CORTISONE AND STEROIDS Photograph was taken 18 February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 17
  18. 18. DOCTOR WAS NOT HAPPY WITH THE PROGRESS AND SEND PATIENT TO EAR NOSE AND THROAT SPECIALIST (ENT) ON FRIDAY 21 FEBRUARY 2014 CONFIRMED THAT ITS MORE THAN JUST CRANIAL NERVE 7 OTHER NERVES AFFECTED CRANIAL 5 AND 8 ENT DOCTOR PRESCRIBED EYE CREAM (DURATEARS+) AND TO CLOSE THE LEFT EYE AT NIGHT USING AN EYE PATCH +(DURATEARS: LUBRICATING EYE OINTMENT IS A MULTI-USE PRESERVATIVE FREE OINTMENT THAT HAS BEEN SPECIALLY FORMULATED FOR THE SYMPTOMATIC TREATMENT OF DRY EYE CONDITIONS. THE OINTMENT FORMS A SMOOTH, COMFORTABLE PROTECTIVE FILM WHEN APPLIED TO THE EYES. IT IS PARTICULARLY EFFECTIVE FOR USE WHILE SLEEPING AND IN PATIENTS WHO ARE SENSITIVE TO PRESERVATIVES OR WHERE THE USE OF PRESERVATIVES IS CONSIDERED INAPPROPRIATE. EAR NOSE AND TROAT SPECIALIST DIAGNOSIS 7/19/2014Jacqui van Wyk Therapeutic Health Options 18
  19. 19. CRANIAL NERVE 5 TRIGEMINAL NERVE The trigeminal nerve is a nerve responsible for sensation in the face and certain motor functions such as biting and chewing. It is the largest of the cranial nerves. Its name derives from the fact that each trigeminal nerve, one on each side of the pons, has three major branches: ophthalmic nerve (V1) maxillary nerve (V2) mandibular nerve (V3) The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has both cutaneous and motor functions. Sensory information from the face and body is processed by parallel pathways in the central nervous system. The motor division of the trigeminal nerve is derived from the basal plate of the embryonic pons The sensory division originates from the cranial neural crest. 7/19/2014Jacqui van Wyk Therapeutic Health Options 19
  20. 20. 3 BRANCHES OF TRIGEMINAL NERVE The ophthalmic, maxillary and mandibular branches leave the skull through three separate foramina: superior orbital fissure foramen rotundum foramen ovale •The ophthalmic nerve (V1) carries sensory information from the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose (including the tip of the nose, except alae nasi), the nasal mucosa, the frontal sinuses, and parts of the meninges (the Dura and blood vessels). •The maxillary nerve (V2) carries sensory information from the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. •The mandibular nerve (V3) carries sensory information from the lower lip, the lower teeth and gums, the chin and jaw (except the angle of the jaw, which is supplied by C2- C3), parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/position and pain/temperature sensation from the mouth. It does not carry taste sensation (chorda tympani is responsible for taste), but one of its branches, the lingual nerve, carries somatic sensation from the tongue. 7/19/2014Jacqui van Wyk Therapeutic Health Options 20
  21. 21. CRANIAL NERVE 8 VESTIBULOCOCHLEAR The vestibulocochlear nerve consists mostly of bipolar neurons and splits into two large divisions: cochlear nerve vestibular nerve The cochlear nerve travels away from the cochlea of the inner ear where it starts as the spiral ganglia. Processes from the organ of Corti conduct afferent transmission to the spiral ganglia. It is the inner hair cells of the organ of Corti that are responsible for activation of afferent receptors in response to pressure waves reaching the basilar membrane through the transduction of sound. The exact mechanism by which sound is transmitted by the neurons of the cochlear nerve is uncertain; the two competing theories are place theory and temporal theory . The vestibular nerve travels from the vestibular system of the inner ear. The vestibular ganglion houses the cell bodies of the bipolar neurons and extends processes to five sensory organs. Three of these are the cristae located in the ampullae of the semicircular canals. Hair cells of the cristae activate afferent receptors in response to rotational acceleration. The other two sensory organs supplied by the vestibular neurons are the maculae of the saccule and utricle. Hair cells of the maculae activate afferent receptors in response to linear acceleration. 7/19/2014Jacqui van Wyk Therapeutic Health Options 21
  22. 22. RELEASE SOME ENDORPHINS AND SEROTONIN 7/19/2014Jacqui van Wyk Therapeutic Health Options 22
  23. 23. MONDAY 24 FEBRUARY 2014 STARTED WORKING AGAIN. WAS SUPPOSE TO ONLY WORK HALF DAY BUT YOU KNOW HOW IT IS – WE NEVER DO Photograph taken 27 February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 23
  24. 24. THERAPEUTIC REFLEXOLOGY TREATMENT STARTED TWICE A WEEK ON 4TH MARCH 2014 Photograph was taken 6 March 2014 Reflexology is the science of using the principals that the feet hands and ears are the mirror image of what is happening in the body Treatment was working on the cranial nerves especially Cranial Nerve 5, 7,8 7/19/2014Jacqui van Wyk Therapeutic Health Options 24
  25. 25. CONTINUES TREATMENT OF THE MEDICATION AND THERAPEUTIC REFLEXOLOGY Photograph was taken 9 March 2014 JUST A LITTLE ON WHAT WAS WORK ON THE PATIENT FROM A THERAPEUTIC REFLEXOLOGY POINT OF VIEW • WORKING THE LARGE TOES REFERS TO WORKING THE BRAIN • THE DORSUM OF THE FOOT WAS WORKED TO ASSIST IN HELPING THE FACIAL NERVES TO RECOVER • ADRENAL REFLEXES TO ENCOURAGE NATURAL CORTISONE RELEASE • NECK MUSCLES TO RELEASE THEM AND THE FACIAL MUSCLES • NECK VERTEBRAE REFLEXES TO RELEASE THEM 7/19/2014Jacqui van Wyk Therapeutic Health Options 25
  26. 26. SEE THE DIFFERENCE ON THE FACIAL NERVE Photograph taken 13 March 2014 Photograph taken 13 February 20147/19/2014Jacqui van Wyk Therapeutic Health Options 26
  27. 27. PICTURES TELL A THOUSAND WORDS Photograph take 20 March 2014 Photograph taken 27 March 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 27
  28. 28. NEW THERAPIST TOOK OVER DUE TO ILLNESS OF FIRST THERAPIST (28 MARCH 2014) Photograph taken 12 April 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 28
  29. 29. STILL ON THE SAME MEDICATION AND CONTINUE TREATMENT OF THERAPEUTIC REFLEXOLOGY(TWICE A WEEK) Photograph taken 10 May 2014 Photograph taken 24 May 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 29
  30. 30. SHIATSU THERAPY WAS STARTED ON 4TH APRIL 2014 TO HELP RELAX THE NECK MUSCLES Shiatsu Therapy: Scientific explanation is that shiatsu calms an overactive sympathetic nervous system, which improves circulation, relieves stiff muscles, and alleviates stress. Lots of work was done on the muscles of the neck (Sternocleidomastoideus, Levator Scapulae, Trapezius) and on the face (Masseter, Temporalis) Treatment was done twice a week 7/19/2014Jacqui van Wyk Therapeutic Health Options 30
  31. 31. WHAT A DIFFERENCE Photograph taken 12 July 2014 Riana continues with her treatment of Therapeutic Reflexology once a week now and the Shiatsu Therapy twice a week. She is still on the chill meds. Almost full recovery grading 2 now Photograph taken 13 February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 31
  32. 32. BIBLIOGRAPHY • GOOGLE INTERNET IMAGES • PROF P MASON (COURSE NEUROBIOLOGY) • GOOGLE WIKIPEDIA • ANATOMY TEXT BOOK FOURTH EDITION • HUMAN ANATOMY AND PHYSIOLOGY • CLINICAL ANATOMY SEVENTH EDITION • MIMS • RIANA THEDVALL • SHARON DU RAAN 7/19/2014Jacqui van Wyk Therapeutic Health Options 32
  33. 33. THANK YOU • THANK YOU TO PROF MASON • THANK YOU TO PROF MASON AND HER TEAM • SPECIAL THANK YOU TO MY PEERS FOR TAKING THE TIME TO READ MY MATERIAL • THANK YOU TO MY COLLEAGUE AND FRIEND LAUREN RICHER • THANK YOU TO MY PATIENT AND FRIEND RIANA THEDVALL • THANK YOU TO MY MENTOR, COLLEAGUE AND FRIEND SHARON DU RAAN PROF MASON WITH ALL THE KNOWLEDGE YOU GAVE US ON THIS COURSE WE CAN ONLY SAY A HUGE THANK YOU 7/19/2014Jacqui van Wyk Therapeutic Health Options 33

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