Charles Bell describe Bell's Palsy. It's LNM lesion. paralysis of the facial muscle; loss of facial expression. Idiopathic in nature. Most of Patient recover from Bell's Palsy 20 to 25 days. #purvishah #Bell'sPalsyICIDH2Format.

1. -Purvi Shah
(B.P.T)

2. INTRODUCTION
 It is a most common neurologic disorders affecting 7th the
facial nerve.
 Unilateral, peripheral facial paresis or paralysis without a
detectable cause.
 Facial nerve affect just above stylomastoid foramen &
produce BELL`S PALSY.
 It`s LMN lesion.

6. Etiology : Idiopathic
Positive family history
Clinical features : Maximum paralysis in 24 h
Posterior auricular pain
Loss of taste sensation
Watering of eyes
Sweating less on affected side
loss of wrinkles in forehead

7. Bell’s Phenomenon : while attempting eye closure eye ball
turn upward & outward
On showing teeth lips do not separate on affected side
Whistling is not possible
Nasolabial fold flat
Angle of mouth drops with dribbling of saliva
Cheeks puff out
Food collects between cheeks & teeth
Heaviness in the face & loss of facial expression
Crocodile tear occur due to annamulus nerve supply

8. ICIDH2 Format
 Impairment
1. Structural Impairment
Affection of facial nerve above stylomastoid foramen
Affection of nerve to stapedius
Affection of posterior auricular nerve
Affection of nerve to digastric belly
Affection of nerve to stylohyoid
Affection of chorda tympani
Affection of greater petrosal nerve
Affection of zygomatic braches

9. Impairment
 2. Functional impairment
Maximum paralysis of whole face of the same side
Hyperacusis
Loss of taste sensation (anterior 2/3rd part of tough)
Loss of facial expression
Loss of lacrimation
Lack of salivation
Difficulty in swallowing
Flattering of nasolabial fold

10. Activity limitation
 Difficulty in swallowing
 Difficulty in facial movement
 Difficulty in smiling
 Difficulty in communication activities
 Difficulty in eye closure

11. Participation Restriction
Restriction in area of education & work
 Restriction in familiar occasion

12. Contextual factor
 Personal factor
Age- 15 to 60 years
Gender- Affect males & females equally
Race- Americans (whites>blacks)

13. Environmental factor
 Occupational exposure
 Social background

14. Investigation : Lab test (to rule out diabetes)
CSF analysis (to rule out GBS)
CT Scan & MRI (to rule out tumor)
EDT : Minimal nerve excitability test
Maximal stimulation test
NCV

15. PHYSIOTHERAPY
 Local Heat (over nerve trunk) : SWD disc electrode
method
Massage : Kneading, Effleurage, superficial stroking
 US(over nerve trunk)
 ES : Ig current
SF current
 Eye protection : wear dark glasses, wash eye zinc boric
solution for prevention of conjunctivitis
 Visual feedback exercise

16. Electrical Stimulation

17. Massage

18. Exercises

20. Exercise :Tightly closure your eyelid
Raise your eyebrow
To make pout
To puff out your face
Bell’s palsy splint
Strengthening exercise

21. Surgical Treatment : Facial nerve decompression
Facial nerve grafting
Tarsorrhaphy