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Facial pain bells_palsy(1)
- 1. FACIAL PAIN BELLS PALSY DR. DARAB SINGH ASSISTANT PROFESSOR MEDICINE DEPARTMENT PMCH UDAIPUR
- 2. Causes of facial pain • Trigeminal neuralgia • Migranous neuralgia • Post herpetic neuralgia • Glossopharangeal neuralgai • Psychogenic (Atypical facial pain) • Tempomandibular arthritis • Malocclusion • Sinusitis, cavernous sinus syndrome ( Tolosa- hunt syndrome) • Oral infection • Ulcer • Abscess • Facial injury • Toothache • Cold sore by HSV-1
- 3. Diagnosis • X ray • MRI • ECG for facial pain by Heart
- 4. TRIGEMINAL NERVE • Largest Cranial Nerve V1-opthalmic - Passes through Superior Orbital Fissure V2- Maxillary – Foramen Rotundum V3- Mandibular – Foramen Ovale
- 6. TRIGEMINAL NEURALGIA • A disorder of the trigeminal nerve (fifth) that causes episodes of sharp, stabbing pain in the cheek, lips, gums, or chin on one side of the face. • Pain seldom lasts more than a few seconds or a minute or two but may be so intense that patent winces, hence term tick. • trigeminal neuralgia gets itsFrench nickname • ‘tic douloureux’, meaning "painful twitch”. • • Commonly in middle aged or elderly people • • F>M • Incidence 4-8 per 100,000
- 8. Pathophysiology • Compression Of Trigeminal Nerve Root By Blood Vessel( superior cerebellar artery, tortuous)---- Demyelination – Ectopic Generation Of Action Potential -- Hyperexcitabllity
- 10. Trigger factor • Touching • Washing of face • Shaving • Teeth cleaning • Cold breeze Eating • Talking • Application of lotions and cosmetics
- 11. DIFFERNTIAL DIAGNOSIS • Migraine or cluster headache • Temporal arteritis – ESR rise • Mass- Aneurism, NF, Acoustic schwannoma or meningiomas
- 12. TREATMENT • 1. Medical - Carbamazepine DOC • 2. Surgical
- 14. SURGICAL • 1. Injection of phenol or alcohol into a trigeminal ganglion • 2. Radiofrequency thermal rhizotomy • 3. Sectioning of sensory root of trigeminal ganglion inside the cranium • 4. Microvascular decompression by suboccipital craniotomy
- 16. BELLS PALSY • Most common form of facial paralysis. • Incidence of idopathic 25 per 100,000 • Risk factor- Pregnancy & DM
- 18. Clinical Manifestation • Abrupt onset, maximum weakness at 48 h • Pain behind ear may precede paralysis for a day or two. • Taste sensation may be lost unilaterally • Hyperacusis may be present • MRI – Swelling and uniform enhancement of geniculate ganglion & facial nerve • 80 % recover within a few weeks or months
- 19. Pathophysiology • Mostly reactivation of HSV-1 in geniculate ganglion • Reactivation of Varicella Zoster virus (1/3) • Reported in recipient of intranasal Influenza vaccine
- 20. Differential Diagnosis • Lyme disease (Borrelia burgdorferi) may cause unilateral or bilateral facial paralysis • Ramsay Hunt syndrome – severe facial palsy plus vesicular eruption in external auditory canal • B/L in Sarcodisis & GBS • Leprosy • Facial Neuropathy – in DM, Sjogren syndrome & amyloidosis • Melkersson-Rosenthal syndrome – Recurrent facial palsy & plication of tounge • Acostic neuroma • Infarct, demyelination lesion of MS & tumor are common pontine lesion • Tumor invade temporal bone ( carotid body, cholestatoma,dermoid) • Supranuclear Facial palsy- Frontalis & orbicularis oculi are involved less than lower part of face , Since upper facial muscle are innervated by corticobulbar pathways from both motor cortex.
- 21. LAB DIAGNOSIS • Diagnosis of BELLS PALSY usually Clinically • ESR • Testing of DM • Lyme titer • Angiotensing converting enzyme & chest imaging for Sarcoidosis • Lumbar Puncture for GBS • MRI
- 23. TREATMENT • Paper tape to depress upper eyelid • Prednisolone – 60-80 mg daily for 5 days then taper over next 5 days • Antiviral – Valacyclovir 1000 mg daily for 5-7 days or Acylovir 400 mg five time daily for 10 days • Cosmetic surgical procedure for permanantly paralysis with bells palsy