Introduction to Bell’s palsy.
Bell’s palsy,It is also known as “idiopathic peripheral facial paralysis”, Considered an idiopathic disorder, no specific cause was conclusively identified. Once other causes of facial palsy have been ruled out, the patient is said to have “Bell’s palsy.”
It is one of the most common causes of acute unifacial paralysis, accounting for “60 and 70 percent” of all unifacial paralysis cases.
definition:
Its peripheral facial paralysis”LMN”, caused by peripheral CN VII dysfunction, which involves weakness or paralysis, usually on one side of the face.
- Starts suddenly and worsens within 48 hours.
- Rapid onset.
Temporary loss of control of facial muscles on the affected side.
Innervation of CN VII “facial nerve”:
- facial muscles.
- lacrimal gland.
- sublingual glands.
- submandibular gland.
- nasal mucosa.
- Oral cavity, nasopharynx.
- stapedius muscle.
- Sensory information about taste. “The front ⅔. of the tongue.
Pathological process:
The facial nerve is damaged by inflammation within the nerve, causing it to widen at the point where the nerve exits the skull through the stylomastoid foramen.
Inflammation or injury of lower motor neurons.
- Inflammation in both contralateral and ipsilateral motor cortex disappeared face.
- Loss of inflammation from contralateral motor cortex face down.
- All muscles on the same side are paralyzed.
Signs and symptoms of Bell’s palsy:
- Weakness on one side of the face. Weakness on one side of the face may be partial or complete.
- There are no wrinkles on the forehead.
- Drop into eyelid.
- Hang down one side of the mouth.
- Slobber.
- Unable to close eyes completely.
- Eyes watery and sore.
- Pain in the face.
- Loss of taste.
- Allergic to sound.
Causes of Bell’s palsy:
- The main reason is unknown.
- Virus origin. “Herpes Complex Virus.” Common Causes.
- Reduced blood supply to the facial nerve.
- Inflammation of the facial nerve.
- Motor cortex disorders. “LMNL”
Risk factors:
- History of viral or bacterial infection.
- Sarcoidosis.
- diabetes.Private letter
- Pregnant.
- hypertension. HTN
complication:
- Abnormal growth of facial nerve fibers.
- Permanent damage to the facial nerve.
- Corneal dryness leads to decreased vision.
diagnosis:
- Medical history and physical examination.
- brain imaging. CT scan, MRI.
Differential diagnosis:
- brain tumor.
- Myasthenia gravis.
- Central nervous system tumors.
- stroke.
- HIV infection.
- multiple sclerosis.
- Guillain-Barre Syndrome.
- Ramsay-Hunter syndrome.
- Melkson-Rosenthal syndrome.
- Lyme disease.
- Facial nerve trauma.
Treatment and Management:
** Spontaneous solution:
- Most patients (70%) fully recover within 3 to 4 months without any medication.
- less common, Symptoms are always there and never go away.
** anti-inflammatory drugs “Corticosteroids”.
** Physiotherapy Management:
- Promotes control and coordination of facial muscles.
- Refine facial movements for specific functions, such as “speak or close eyes,” with strengthening exercises.
- Refine facial expressions such as smiling.
- Facilitate practice.
- Corrects abnormal facial movement patterns that may occur during recovery.
- Patient education and advice.
- Low laser treatment.
- massage: The face still feels intact, so massage within the pain tolerance is an important intervention for Bell’s palsy patients to keep loose muscles elastic and well nourished.
Is electrical stimulation beneficial for Bell’s palsy?
Some studies show that:
“No papers found referring to ES Use in Physical Therapy for Bell’s Palsy in the Acute Setting”.
There is no evidence that exercise or electrical stimulation Beneficial for patients with acute Bell’s palsy
refer to:
- R;, G. (nd). Pathogenesis of Bell’s palsy.Fibrous compression neuropathy after retrograde epineurial edema and facial nerve edema. Annals of Otology, Rhinology, and Laryngology. . Retrieved January 23, 2023 from https://pubmed.ncbi.nlm.nih.gov/889228/
- JM VanSwearingen (2017, 21 September). Guideline: Physical Therapy Guidelines for Bell’s Palsy. Select Pacific Islands. Retrieved January 23, 2023 from https://www.choosept.com/guide/physical-therapy-guide-bells-palsy
- Buttress, S. (2002). Electrical stimulation and Bell’s palsy. Journal of Emergency Medicine, 19(5). https://doi.org/10.1136/emj.19.5.428-a
- Loyo, M., McReynold, M., Mace, JC, and Cameron, M. (2020). Protocol for a randomized controlled trial of high-voltage bimodal electrical stimulation versus placebo for restoration of facial function in patients with unfavorable prognosis for acute Bell’s palsy. Rehabilitation and Assistive Technology Engineering Journal, 7205566832096414. https://doi.org/10.1177/2055668320964142
