Bell's palsy By Akond.

Presentation on:
Bell’s Palsy

Presented by :
Mahashin akond
BSc in physiotherapy
IHT.Dhaka.Bangladesh.

Bell’s palsy(Facial Nerve Palsy):
This is a condition in
which there is a lesion
of the facial nerve and
resultant paralysis in
the muscles that it
supplies.
Reference:Tidys physiotherapy 12thedition
Facial nerve supply

The main facial muscles affected are::
1. Occipitofrontalis ―
Raises eyebrow.
2. Orbicularis oculi ―
Closes eye.
3. Corrugator and procerus
― Wrinkle skin between
eyebrows and frowns.
Reference: Tidys physiotherapy 12thedition

4.Zygomatic us major
and minor, Levator
anguli oris,levator labii
superioriss-Raise the
corner of the mouth and upper
lip
5. Orbicularis oris - Closes
the mouth.
6. Risorius ― Pulls the angle
of the mouth back, as in
grinning.

7. Buccinator - Keeps the
cheek against the teeth
during mastication or
sucking.
Without it, food is trapped
between the cheek and
teeth which is functionally
highly restricting.

8. Depressor anguli 0ris and
depressor labii in ferioris ― Pull
down the angle of the: mouth and
the lower lip.
9. Mentalis ―- Wrinkles the chin
and is very important in drinking
because it holds the lower lip on
the cup and prevents dribbling.
The nerve also supplies taste
sensation to the palate and
anterior two-thirds of the tongue
and the parasympathetic supply
to the secretomotor salivary
glands.

Aetiology:
The cause is unknown. It can occur at any age and is not
gender specific..
Onset:
This is often sudden. The patient may have a
history of earache or of having been in a draught.
Often the patient wakes up with the paralysis,
having been perfectly normal the night before.

Pathology:
The facial nerve becomes swollen and hyperemic
within the facial canal. in which there is limited
space. The nerve rapidly becomes compressed and
conductivity is lost.

Prognosis:
Fifty per cent recover within 3 months.
Clinical features ― on the side 0f the lesion
1. Loss of facial expression.
2. Drooping of the face - lower eyelid, eyebrow and
corner of the mouth sag.
3. Closing the eye is difficult.

Prognosis::
4. Eating is difficult because food collects in the
side of the cheek and fluids seep out of the
corner of
the mouth.
5. Speaking, whistling and drinking are impaired.
6. Non-verbal communication is lost as the
patient cannot register pleasure, laughter,
surprisc,interest or worry.
7. The patient tends to sit with the hand over the
side of the face.

Treatment:
Oral steroids may be given to reduce
inflammation.
Surgery may be used in longstanding cases to
improve appearance. The eyelids may be stitched
together to protect the eye.

Physiotherapy:
During paralysis
1. Ultrasound given over
the nerve trunk just in
front of the tragus of the
ear may reduce the
Inflammation.

2.Massage may be taught
to the patient:
(a) Stroking in an upward,
outward direction.
During paralysis

b) Slow finger kneading
applied over the
paralysed muscles
maintains skin
suppleness and
muscle elasticity.

3.advice:
(a) The patient should lie down at intervals
throughout the day to reduce the effects of gravity
on the paralyzed muscles.
(b) The .eye should be bathed regularly because the
normal blanking reflex is lost and dust particles
collect, producing conjunctivitis .

Recovery stage:
Mild infra-red treatment may be applied to warm he
muscles and improve function ― the eye must
protected with wet cotton wool.
PNP techniques are used for re―education:
1. Quick stretch technique can be applied to regain raising of the
eyebrow and the movements of the
corner of the mouth.
2.The physiotherapist can produce the movement passively then
ask the patient to hold, then try to produce the movement.
3. Icing, brushing, tapping or brisk stroking may be applied along the
length of the muscles, e.g. the zygomatics

Exercises:
1. Look surprised then
frown.
2. Squeeze eyes closed
then open wide.
3. Smile, grin, say ‘o’.

4. Say ‘a, e, i, 0, u'. -
5. Hold straw in mouth ―
suck and blow.
6. Whistle-These exercises
are performed in lying at
first, then sitting up. The
patient may assist at first
then progress to resisting.
A mirror is useful to
enable the patient to
observe the muscle
activity.

Failure to recovery:
1. In a complete recovery, it
persist 3 months.
2. we can also use electrical
stimulation-pulse width
80s,frequence:5-8Hz,voltage
0-18V,program:2s on/2s off
for 3-5h daily in two session.
3. Has been improve facial
muscle.

Bell's palsy By Akond.

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