Bell's palsy is an acute facial paralysis caused by inflammation of the facial nerve, with various potential etiologies including viral infections and cold exposure. Symptoms include drooping of the eyelid and mouth, loss of taste, and auditory hypersensitivity. Treatment typically involves physiotherapeutic approaches such as electrical stimulation, facial massage, and exercises to improve muscle strength.

1. BELL’S PALSY
S.CHRISTY SOPNA
PHYSIOTHERAPIST

2. DEFINITION
Bell’s palsy is a facial paralysis of acute onset presumed to be due to non-
suppurative inflammation of unknown etiology of the facial nerve within its canal
above the stylomastoid foramen.

3. ETIOLOGY
u History of exposure of the ear to extreme cold
u Water retention in pregnancy
u Infection of the ear(otitis media )
u Upper respiratory tract infection
u Idiopathic
u VIRAL INFECTIONS – Herpex simplex
Epstein Barr
varicella-zoster
u BACTERIAL INFECTION – Borrelia burgdorferi

4. Bells palsy
u Damage to the 7th cranial nerve (FACIAL NERVE)
u AFFECT :
u LACRIMAL GLAND- produces tears
u MUCOUS MEMBRANE – nose, mouth and nasopharynx
u SUBMANDIBULAR, SUBLINGUAL GLAND – produces saliva
u Affect taste in anterior 2/3rd of tongue

5. BELL’S PALSY VS FACIAL PALSY
BELL’S PALSY FACIAL PALSY
LMN (lower motor neuron lesion ) UMN (upper motor neuron lesion)
The nerve get affected in its nerve
course from stylomastoid foramen
Lesion in brain or brainstem
All muscles paralysed on affected
side
Paralysis of muscles on the lower half
of the face on the contralateral side
of face

7. SYMPTOMS
u Drooping eyelid
u Absence of nasolabial fold
u Drooping mouth
u Dryness in affected eye or mouth
u Hypersensitivity to loud noises (HPERACUSIS)
u Loss of taste sensation on anterior 2/3rd of tongue

9. MUSCLES AFFECTED
u Frontalis
u Corrugator supercili
u Orbicularis oculi
u Nasalis
u Levator labi superioris and inferioris
u Risorius
u Buccinator
u Depressor labi orbicularis oris
u Mentalis

10. TYPES OF NERVE INJURY
u NEUROPRAXIA
u AXONOTOMESIS
u NEUROTOMESIS

11. CASE STUDY
A 50 year old man came with a Condition of weakness in right side face, Slurring of
speech, inability to close right eye, deviation of mouth to left side & reduced
sensation in the right side tongue, Thus accumulation of food in right side and
drooling of water therefore the patient complains severe pain in the nerve course.

12. ON OBSERVATION
u Incomplete closure of eye
u Left side deviation of mouth
u Sagging face
u Absence of nasolabial fold

13. ON PALPATION
u Dryness of face
u Saggy muscles

14. SPECIAL TESTS
u Bells phenomenon – positive
u Marin amat phenomenon – negative

15. EXAMINATION
u MUSCLE POWER ASSESMENT
u Housebrackmann facial nerve grading system
u Sunnybrook facial grading system
u Faradic galvanic test – to find out whether the nerve is innervated or
denervated
u Strength duration curve - to find out whether the nerve is innervated ,
partially innervated or denervated

18. PHYSIOTHERAPEUTIC TREATMENT
u Electrical stimulation – surged faradic and interrupted galvanic
u Infrared(IR) and short wave diathermy (SWD)– to increase circulation to resolve
inflammation
u facial massage – upward direction
deep friction massage and kneading
u Taping or splinting – eye and mouth
u Eye care – instruct patient to wear goggles
u Visual feedback exercise
u Strengthening exercise
u Balloon blowing
u Candle blowing
u Telling vowels a,e,I,o,u

20. FUNCTIONAL SCALING
SCALE PRE INTERVENTION 1st WEEK 2nd WEEK
SUNNY BROOK 55 30 2

21. THANK YOU