Bell's Palsy project for Neurobiology

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
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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.
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3. 12 CRANIAL
NERVES
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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
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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.
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6. TEST THEY USE TO DETERMINE THE GRADE OF BELL’S PALSY
HOUSE-BRACKMANN SCORE
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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
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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
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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
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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
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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
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12. FACIAL NERVE
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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
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14. RIANA THEDVALL
Name: Riana Thedvall
Age: 39 years
Occupation: Project Manager
Diagnosed with Bell’s Palsy: 10 February 2014
Severity: Grade VI
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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 EVENING 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
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16. SAW THE DOCTOR MONDAY 10 FEBRUARY2014
DOCTOR REFERRED HER TO A NEUROLOGIST,
NEUROLOGIST ADMITTED HER TO HOSPITAL
MEDICATION GIVEN INTRAVENOUSLY: STEROIDS AND CORTIZONE
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
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17. MEDICATION WAS GIVEN FOR 10 MORE DAYS
CORTISONE AND STEROIDS (TABLETS)
Photograph was taken 18 February 2014
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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
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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.
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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.
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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.
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22. RELEASE SOME ENDORPHINS AND SEROTONIN
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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
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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
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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
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26. SEE THE DIFFERENCE ON THE FACIAL NERVE
Photograph taken 13 March 2014 Photograph taken 13 February 2014
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27. PICTURES TELL A THOUSAND WORDS
Photograph take 20 March 2014
Photograph taken 27 March 2014
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28. NEW THERAPIST TOOK OVER DUE TO ILLNESS OF FIRST THERAPIST
(28 MARCH 2014)
Photograph taken 12 April 2014
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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
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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
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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.
Full recovery grading
I
Photograph taken 13 February
2014
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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
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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
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