exam question regarding bells palsy

1. BELLS PALSY
JAMEEL KIFAYATULLAH

2. Bells Palsy
• A 30 year old female patient reports to you with
Bells palsy of the right side of the face for the last
two years.She wants to get her smile restored
and synchronized with other side.
• a) What are treatment options available for such
patients?
• B) What better option will you choose and
explain to this patient?
• C) What special precautions will you take during
future periapical/dentoalveolar surgeries in
anterior maxilla in this patient?

3. Non Surgical Treatment options
• Botox
• Facial Filler
• Physical Therapy

4. treatment options
• Cross-facial reinnervation procedures
performed by wiring new nerve connections
from facial nerve branches on the working half
of the face to paralyzed areas
• The masseteric nerve
• The hypoglossal nerve

5. treatment options
• Static Procedures
• Lower face:
• Static sling to raise the corner of the mouth at
rest using tissue from the thigh or artificial
tissue such as Gore-Tex
• Facelift
• Lower lip wedge resection/surgical removal

6. Treatment options
• Surgery for Chronic Facial Paralysis: Dynamic Procedures
• temporalis tendon transfer (T3)
• free muscle transfer with the gracilis muscle.
In free tissue transfers, distant muscle and nerves can be
transferred from other parts of the body and attached to a
new blood supply, such as the gracilis muscle from the
thigh, the pectoralis minor muscle from the chest or a
muscle from the back. The transferred nerve can be
attached to the proximal facial nerve or to a crossover
nerve graft connected to the non-paralyzed side, and finally
to a motor nerve borrowed from a chewing muscle.

7. What better option will you choose
and explain to this patient?
• If the paralysis has been present for more
than two years, however, a nerve transfer
procedure is less likely to be effective and a
new muscle must be used to provide motion
for the smile. The most common procedures
to accomplish this include the temporalis
tendon transfer (T3) and free muscle transfer
with the gracilis muscle.

8. What special precautions will you take
during future periapical/dentoalveolar
surgeries in anterior maxilla in this
patient?
• Careful handling of tissues e.g lips ,cheeks in
order to prevent damage to nerve or muscle
transferred
• Careful use of retractors and hanpieces.