This document discusses facial paralysis, its causes, Bell's palsy, and treatment. It states that the most common cause of facial paralysis is Bell's palsy, which accounts for 60-70% of cases. Bell's palsy is an idiopathic, acute-onset paralysis or weakness of the facial nerve. It can be caused by viral infections like herpes simplex. Diagnosis involves clinical examination, laboratory tests, and electrophysiology tests. Treatment includes steroids, antivirals, physiotherapy, and in rare cases nerve decompression surgery. The prognosis is generally good, with 85-90% of patients recovering fully and 10-15% having some lingering effects.

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….