BELL’S PALSY By: Josfeena Bashir Lecturer, BGSBU DEFINITION Bell’s palsy (facial paralysis) is caused by unilateral inflammation of the seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side INCIDENCE Younger than 45 years of age Men & women are affected equally CAUSES Although the cause is unknown, Theories about causes include Vascular ischemia, Viral disease (herpes simplex, herpes zoster), Autoimmune disease, a combination of all of these factors. NERVE TRAUMA Risk factor The third trimester of pregnancy In individuals with immune disorders such as HIV infection, Individuals with diabetes. Viral upper respiratory infection Pathophysiology Etiology Inflammation of facial nerve The inflamed, oedematous nerve becomes compressed to the point of damage, or its blood supply is occluded, Producing ischemic Necrosis of facial nerve Paralysis of facial nerve Clinical manifestation Onset of symptoms may be sudden or may progress over a 2- to 5-day period Pain behind the ear may precede the onset of facial paralysis dry eye or tingling around the lips  Unable to Close The Eyelid, Wrinkle The Forehead, Dysarthria & dysphagia The mouth is pulled toward the unaffected side Drooling of saliva occurs, the affected eye has constant tearing or lacrimation. Sense of taste is lost over the anterior two-thirds of the tongue Diagnostic evaluation History of the onset of symptoms is used to diagnose Bell’s palsy. Observation of the patient confirms the diagnosis. An EMG may be done. The possibility of a stroke must be ruled out. Management Corticosteroid therapy- to decrease inflammation (eg, prednisone 1 mg/kg/day for 10 to 14 Acyclovir combined with prednisone is possibly effective in improving facial function Eye care to maintain lubrication and moisture if unable to close. May need to be patched during sleep. Physical therapy, electrical stimulation to maintain muscle tone. Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics to relieve pain Heat application Massage Electrical stimulation Surgical management Tarsorrhaphy Complication Corneal ulceration Impairment of vision Body image disturbance related to facial nerve paralysis Nursing management Test motor components of facial nerve (VII) by assessing patient's smile, ability to whistle, purse lips, wrinkle forehead, and close eyes. Observe for facial asymmetry. Observe patient's ability to handle secretions, food, fluids; observe for drooling. Assess patient's ability to blink and speak clearly. Assess effect of altered appearance on body image. Administer or teach patient to administer artificial tears and ophthalmic ointment as prescribed 

1. BELL’S
PALSY
By:
Josfeena Bashir
Lecturer, BGSBU

2. DEFINITION
Bell’s palsy (facial paralysis) is
caused by unilateral
inflammation of the seventh
cranial nerve, which results in
weakness or paralysis of the
facial muscles on the affected
side

3. INCIDENCE
Younger than 45 years of
age
Men & women are
affected equally

4. CAUSES
Although the cause is unknown,
Theories about causes include
Vascular ischemia,
Viral disease (herpes simplex, herpes
zoster),
Autoimmune disease, a combination of all
of these factors.
 NERVE TRAUMA

5. Risk factor
The third trimester of pregnancy
In individuals with immune disorders such as HIV
infection,
Individuals with diabetes.
Viral upper respiratory infection

6. Pathophysiology
Etiology
Inflammation of facial nerve
The inflamed, oedematous nerve becomes compressed to the point of
damage, or its blood supply is occluded,
Producing ischemic
Necrosis of facial nerve
Paralysis of facial nerve

7. Clinical manifestation
 Onset of symptoms may be sudden or may progress over a 2- to 5-day
period
 Pain behind the ear may precede the onset of facial paralysis
 dry eye or tingling around the lips
 While lifting, moving or carrying an object keep it close to the body to
prevent unnecessary strain
 Avoid unnecessary bending or reaching to an object. Flex knees to
come close to the object
 Keep work close to the body

8.  Unable to Close The Eyelid,
 Wrinkle The Forehead,
 Dysarthria & dysphagia
 The mouth is pulled toward the unaffected side
 Drooling of saliva occurs,
 the affected eye has constant tearing or lacrimation.
 Sense of taste is lost over the anterior two-thirds of the
tongue

9. Diagnostic evaluation
History of the onset of symptoms is used to
diagnose Bell’s palsy.
Observation of the patient confirms the
diagnosis.
An EMG may be done. The possibility of a
stroke must be ruled out.

10. Management
 Corticosteroid therapy- to decrease inflammation (eg, prednisone 1 mg/kg/day
for 10 to 14
 Acyclovir combined with prednisone is possibly effective in improving facial
function
 Eye care to maintain lubrication and moisture if unable to close. May need to be
patched during sleep.
 Physical therapy, electrical stimulation to maintain muscle tone.
 Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics to relieve pain
 Heat application
 Massage
 Electrical stimulation

11. Surgical management
Tarsorrhaphy

12. Complication
Corneal ulceration
Impairment of vision
Body image disturbance related to
facial nerve paralysis

13. Nursing management
 Test motor components of facial nerve (VII) by assessing patient's smile,
ability to whistle, purse lips, wrinkle forehead, and close eyes. Observe for
facial asymmetry.
 Observe patient's ability to handle secretions, food, fluids; observe for
drooling.
 Assess patient's ability to blink and speak clearly.
 Assess effect of altered appearance on body image.
 Administer or teach patient to administer artificial tears and ophthalmic
ointment as prescribed