Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.

1. CRANIAL NERVE DISORDERS
Mr. ANILKUMAR B R . MS.c Nursing
LECTURER Medical-surgical Nursing

2. Types of cranial nerve disorders
1. Bell’s palsy
2. Trigeminal Neuralgia ( Tic Douloreux)
3. Cranial & spinal neuropathies

3. BELL’S PALSY ( Facial plasy)
• Bell’s palsy (facial paralysis) is due to unilateral
inflammation of the ( CN VII Facial nerve)
seventh cranial nerve, which results in
weakness or paralysis of the facial muscles on
the affected side.

4. • That most often occurs unilaterally.
• Generally self-limiting. With or without
treatment, most clients improve significantly
within 2 weeks and about 80% recover
completely within 3 months.
• in very rare cases the symptoms may never
completely resolve or may recur.

5. Etiological factors
1. Causes is unknown.
2. Although possible causes may include
vascular ischemia, viral disease (herpes
simplex, herpes zoster), autoimmune disease,
or a combination of all of these factors.
3. HIV infection
4. Lyme disease
5. Middle ear infection and Sarcoidosis

6. Clinical manifestations
1. Acute onset of unilateral upper and lower facial
paralysis ( over a 48 hours period).
2. Paralysis of ipsilateral side of face from vertex of
scalp to chin.
3. Facial muscle weak throughout forehead, check,
and chin, can affect speech and taste, distort
face, decreasing tearing and cause posterior
auricular pain.
4. Inability to close eye and painful eye sensation.
5. Photophobia.
6. Hyperacusis on the affected side.

7. Clinical manifestations

8. Clinical manifestations

9. Diagnostic evaluations
1. Bells palsy can be diagnosed just by taking a
health history and doing a complete physical
examination.
2. History to determine previous illness, onset
of paralysis and associated symptoms.
3. Exclusion of lesions that mimic Bell’s palsy,
such as tumor, infection ( Lyme disease,
Meningitis) trauma,, stroke or other
conditions.
4. Neurological examination
5. CT-scan and EMG

10. Medical management
• The objectives of treatment are to maintain
the muscle tone of the face and to prevent or
minimize denervation.
• The patient should be reassured that no
stroke has occurred and that spontaneous
recovery occurs within 3 to 5 weeks in most
patients.

11. Medical management
1. Corticosteroids therapy may be started early
to decrease inflammation ( e.g. Prednisone 1
mg/kg/day for 10 to 14 days.
2. when using Corticosteroids therapy for the
treatment of bell’s palsy, take cautions should
be used client with TB, peptic ulcer, DM,
renal & hepatic dysfunction or malignant
hypertension.

12. 3. Eye care is essential maintain lubrication and
moisture if unable to close the eye. May be
need to be patched during sleeping.
4. Physical therapy , electrical stimulation to
maintain muscle tone.
5. Biofeed back as adjunct therapy
6. Mild analgesics to relieve pain

13. Complications
1. Corneal ulcerations
2. Impairment of vision
3. Psychosocial adjustment to prolonged
paralysis

14. Trigeminal Neuralgia ( Tic Duloureux)

15. Introduction
• The trigeminal nerve which is divided into
three branches, is responsible for chewing, for
producing saliva and tears, and for sending
facial sensations to the brain.
• When this nerve breaks down for some
reason, it can trigger brief but agonizing
sizzles of pain on one side of the face.
• This condition is unusual in those under age
50 and more often occurs after 70.

16. Trigeminal Neuralgia ( Tic Duloureux)
• Trigeminal Neuralgia is a disorder of the
trigeminal nerve (the fifth cranial nerve) that
causes episodes of sharp, stabbing pain in the
cheek, lips, gums, or chin on one side of the
face. Or
• Trigeminal Neuralgia ( Tic Duloureux) is an
intensely painful neurologic condition that
affects one or more branches of the fifth
cranial nerve.

17. The main divisions of trigeminal nerve

18. Etiopathophysiology
1. Unknown causes, but degenerative or viral
origin is suspected.
2. Any of the three trigeminal nerve branches
can be affected
a) V1 – Ophthalmic branch ( pain involves the
eye and fore head.)
b) V2 – Maxillary branch (pain involves the
cheek, upper teeth, upper gums and nose.)
c) V3 – Mandibullar branch (pain involves the
lower jaw, side of tongue, lower teeth, lower
gums, extend ear.)

19. • The main cause is damage to nerve leading to
demyelination of nerve leading to stabbing,
severe, shock like pain of neuralgia results.
FACTORS CAUSING DAMAGE ARE-
1. Old age
2.Infection
3.Multiple sclerosis
4. Pressure on nerves
5. Diabetes

20. Clinical manifestations
1. Sudden severe episodes of intense facial
pain localized to one or more branches of the
TN nerve lasting less than 30 to 6o seconds.
2. pain may occur spontaneously or be
precipitated by activation of trigger points,
such as touching the face, talking, chewing,
and brushing of the teeth.
3. Pain always unilateral & does not cross
midline.
4. Some clients will experience numbness esp.
around the mouth.

21. Diagnostic evaluations
1. History of characteristic symptoms and
pattern.
2. Neurologic & cranial nerve examination.
3. CT –scan & MRI

22. Medical Management
PHARMACOLOGIC
1. Use of carbamazepine is first and most
effective medication used to treat the
condition.
2. Other drugs such as:
a) Imipramine
b) Phenytoin
c) Diavlproex
d) Gabapentin and othe AED may be used

23. Carbamazepine Carbamazepine is used to treat
seizures and nerve pain such as trigeminal neuralgia
and diabetic neuropathy. Carbamazepine is also used to
treat bipolar disorder.

24. • Side effects include nausea, dizziness
drowsiness, and aplastic anemia. The
patient is monitored for bone marrow
depression during long-term therapy.

25. SURGICAL MANAGEMENT
• When these methods fail to relieve pain,
a number of surgical options are
available. The choice of procedure
depends on the patient’s preference and
health status.

26. Microvascular Decompression of the
Trigeminal Nerve
• An intracranial approach can be used to
decompress the trigeminal nerve.
• This procedure relieves facial pain while
preserving normal sensation, but it is a
major procedure, involving a craniotomy.
• The postoperative management is the
same as for other intracranial surgeries.

27. Percutaneous Radiofrequency
Trigeminal Gangliolysis.
• It directs low- voltage stimulation of nerve by
electrode inserted through foramen ovale.
• Under local anesthesia, the needle is
introduced through the cheek on the affected
side. Under fluoroscopic guidance, the needle
electrode is guided through the foramen
magnum into the gasserian ganglion.

28. Complications
1. Anorexia and weight loss
2. Dehydration
3. Anxiety and fear
4. Depression, social isolation and suicidal
ideations in extreme cases.

29. Nursing Management
1. Take history of the pain, including
duration, severity, and aggravating
factors.
2. Assess the nutritional status.
3. Assess for anxiety and depression,
including problems with sleep, social
interaction etc.

30. Nursing Management
• Preventing pain
• Providing postoperative care : postoperative
neurologic assessments are conducted to
evaluate the patient for facial motor and
sensory deficits in each of the three branches
of the trigeminal nerve.
• If the surgery results in sensory deficits to the
affected side of the face, the patient is
instructed not to rub the eye, because pain
will not be felt if there is injury.