complete etiology, treatment and prognosis for facial paralysis

1. FACIAL PARALYSIS
HARIPRASATH T

2. CAUSES OF FACIAL PARALYSIS
 central
1.Brain abscess
2.poliomyelitis
 Intracranial part
1.meningioma
2.meningitis
 Intra temporal part
1.Idiopathic – Bell palsy
2.Infections – ASOM,CSOM

3. CONTD….
3.Trauma – mastoidectomy,fractures of
temporal bone
4.Neoplasms – malignancies of external
and middle ear,facial nerve
neuroma.
 Extra cranial part
Malignancy,surgery,accidental injury to
parotid
 Systemic diseases
DM,Hypothyroidism,Leprosy

4. BELL PALSY
 DEFINITION:
Idiopathic,peripheral facial paralysis or paresis of acute onset
 EPIDEMIOLOGY:
60-70% of facial paralysis is due to bell palsy
both sexes are affected
risk is more in diabetes and pregnency

5. ETIOLOGY
 VIRAL INFECTION
- caused mainly by Herpes simplex ,Herpes
zoster,EBV.
 VASCULAR ISCHEMIA
- PRIMARY: induced by cold or emotional stress
- SECONDARY: result of primary ischemia
causing increased capillary permeability leading to exudation of fluid
,edema and compression of microcirculation of nerve

6. Cont…
 HEREDITARY
-Fallopian canal is narrow because of hereditary
predisposition and this makes the nerve susceptible to early
compression with slightest edema
 AUTO-IMMUNE DISORDER
- T lymphocytes changes have been
observed

7. CLINICAL FEATURES:
 Sudden in onset
 Patient unable to close his eye
 On attempting to close the eyeball turns up and out-BELL
PHENOMENON
 Saliva dribbles from angle of mouth
 Face become asymmetrical
 Tears flow down from the eye-EPIPHORA
 Pain in the ear may precede or accompany the nerve paralysis
 Noise intolerance
 Loss of taste

8. DIAGNOSIS
Diagnosis
1.clinical
2.laboratory
3.electro physiology

9. Cont…
 CLINICAL:
case history
clinical examination-complete otological and head &
neck
 LABORATORY:
X-RAY studies
Blood test-TC , Peripheral smear , ESR , blood sugar
and serology
 ELECTRO-PHYSIOLOGY:
ENG
EMG

10. TREATMENT
 GENERAL
1.Reassurance
2.Relief of ear pain by analgesics
3.Physiotheraphy or massage of the facial muscles
 MEDICAL MANAGEMENT
1.Steroids:DOC –Prednisolone 1mg/kg/day for 5 days bd
2.Acyclovir for herpes is combined with steroids
3.Other drugs:Vasodialators,vitamins,mast cell inhibitors

11. Cont…..
 SURGICAL MANAGEMENT
Nerve decompression relieves pressure on the nerve
fibres and thus improves the microcirculation of the nerve.

12. PROGNOSIS:
 85 – 90% Of the patients recover fully
 10 – 15% recover incompletely and may be left with some
degeneration
 Prognosis is good in incomplete Bell palsy(95% complete recovery)
 Clinical recovery starts within 3 weeks of onset(75%complete
recovery)

13. THANK YOU….