Topic: Bell'S Palsy Presented To: Mr. Idowu Group Members Kareeem Abisola Adeboye Mary Tobi Happiness Abe Favor Oyeniyi Kayode

OBAFEMI AWOLOWO TEACHING HOSPITAL COMPLEX
WESLEY GUILD HOSPITAL, ILESHA
TOPIC: BELL’S PALSY
PRESENTED TO : MR. IDOWU
GROUP MEMBERS
KAREEEM ABISOLA
ADEBOYE MARY
TOBI HAPPINESS
ABE FAVOR
DEFINITION
 Bell's palsy causes sudden weakness in your facial muscles. This makes hal
f of your face appear to droop. Your smile is one-sided, and your eye on tha
t side resists closing.
 Bell's palsy, also known as facial palsy, can occur at any age. The exact cau
se is unknown, but it's believed to be the result of swelling and inflammatio
n of the nerve that controls the muscles on one side of your face. It may be
a reaction that occurs after a viral infection.

CONTINUATION
• For most people, Bell's palsy is temporary. Symptoms us

ually start to improve within a few weeks, with complete
recovery in about six months. A small number of people c
ontinue to have some Bell's palsy symptoms for life. Rare
ly, Bell's palsy can recur.
RISK FACTORS
• Bell's palsy occurs more often in people who:
 Are pregnant, especially during the third trimester, or wh

o are in the first week after giving birth
 Have an upper respiratory infection, such as the flu or a

cold
 Have diabetes
 Family history
CAUSES
Although the exact reason Bell's palsy occurs isn't clear, it's often linked to
exposure to a viral infection. Viruses that have been linked to Bell's palsy
include the virus that causes:
 Cold sores and genital herpes (herpes simplex)
 Chickenpox and shingles (herpes zoster)
 Mononucleosis (Epstein-Barr)
 Cytomegalovirus infections
 Respiratory illnesses (adenovirus)
 German measles (rubella)
 Mumps (mumps virus)
 Flu (influenza B)
 Hand-foot-and-mouth disease (coxsackievirus)
PATHOPHYSIOLOGY
• BELL: derived from Sir Charles Bells
• PALSY: means muscle paralysis
• It is idiopathic, but it is mostly caused by vasospasm along t
he facial nerve branch within the chordea tympani.
• There is compression of the facial nerve which is presented
as retrograde epineural edema and ischemia, this brings abo
ut the dysfunction of the facial nerve. The compression may
be mild or severe which results in reversible or irreversible
ischemic degeneration of myelin sheath and axon.
• This ischemic necrosis of the facial nerve causes distortion
of the face. This will lead to increased lacrimation(tearing),
painful sensation in the face, in the eyes and behind the ear.
SYMPTOMS
 Rapid onset of mild weakness to total paralysis on one side of your face —
occurring within hours to days
 Facial droop and difficulty making facial expressions, such as closing your
eye or smiling
 Drooling
 Pain around the jaw or in or behind your ear on the affected side
 Increased sensitivity to sound on the affected side
 Headache
 A decrease in your ability to taste
 Changes in the amount of tears and saliva you produce

COMPLICATIONS
 mild case of Bell's palsy normally disappears within a month, but
recovery from a more severe case involving total paralysis varies.
Complications may include:
 Irreversible damage to your facial nerve
 Misdirected regrowth of nerve fibers, resulting in involuntary contraction

of certain muscles when you're trying to move others (synkinesis) — for
example, when you smile, the eye on the affected side may close
 Partial or complete blindness of the eye that won't close due to excessive
dryness and scratching of the cornea, the clear protective covering of the
eye
DIAGNOSIS
 Electromyography (EMG). This test can confirm the presence of nerve
damage and determine its severity. An EMG measures the electrical
activity of a muscle in response to stimulation and the nature and speed
of the conduction of electrical impulses along a nerve.
 Imaging scans. Magnetic resonance imaging (MRI) or computerized

tomography (CT) may be needed on occasion to rule out other possible
sources of pressure on the facial nerve, such as a tumor or skull fracture.
PHARMACOLOGY TREATMENT
 Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If
they can reduce the swelling of the facial nerve, it will fit more comfortably
within the bony corridor that surrounds it. Corticosteroids may work best if
they're started within several days of when your symptoms started.
 Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have
shown no benefit compared with placebo. Antivirals added to steroids are also
unlikely to be beneficial.
 However, despite this, valacyclovir (Valtrex) is sometimes given in combination

with prednisone in people with severe facial palsy.
PHYSICAL THERAPY
 Paralyzed muscles can shrink and shorten, causing permanent
contractures. A physical therapist can teach you how to massage and
exercise your facial muscles to help prevent this from occurring.
 Surgery
 In the past, decompression surgery was used to relieve the pressure on the
facial nerve by opening the bony passage that the nerve passes through.
Today, decompression surgery isn't recommended. Facial nerve injury and
permanent hearing loss are possible risks associated with this surgery.
 In rare cases, plastic surgery may be needed to correct lasting facial nerve
problems
NURSING MANAGEMENT
• Reassure the patient that a stroke has not occur and that spontaneous
recovery occur within 3-5weeks in most patient
• Cover the eye with a protective shield at night
• Apply eye ointment to keep eyelids closed during sleep
• Close the paralyzed eyelids manually before going to sleep
• Wear a wrap round sunglasses/ goggles to decrease normal evaporati
on from the eye
• Teach the patient about maintaining muscle tone
• Show patient how to perform the facial massage with gentle upward
motion several times daily when the patient can tolerate the message
• Instruct patient to avoid exposing the face to cold
LIFESTYLE AND REMEDIES
 Protecting the eye you can't close. Using lubricating eye drops during the
day and an eye ointment at night will help keep your eye moist. Wearing
glasses or goggles during the day and an eye patch at night can protect your
eye from getting poked or scratched.
 Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin

IB, others) or acetaminophen (Tylenol, others) may help ease your pain.
 Applying moist heat. Putting a washcloth soaked in warm water on your

face several times a day may help relieve pain.
 Doing your physical therapy exercises. Massaging and exercising your face
according to your physical therapist's advice may help relax your facial
muscles.
ALTERNATIVE MEDICINE
 Relaxation techniques. Relaxing by using techniques such as meditation and
yoga may relieve muscle tension and chronic pain.
 Acupuncture. Placing thin needles into a specific point in your skin helps
stimulate nerves and muscles, which may offer some relief.
 Biofeedback training. By teaching you to use your thoughts to control your

body, you may help gain better control over your facial muscles.
 Vitamin therapy. Vitamins B-12, B-6 and zinc may help nerve growth.
NURSING DIAGNOSIS
• Body image disturbance related to alteration in struc
ture and function for vision evidenced by facial ede
ma
• Disturbed sensory perception related to alteration in
structure and function for vision evidenced by painf
ul sensation of the face

Topic: Bell'S Palsy Presented To: Mr. Idowu Group Members Kareeem Abisola Adeboye Mary Tobi Happiness Abe Favor Oyeniyi Kayode

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OBAFEMI AWOLOWO TEACHING HOSPITAL COMPLEX

WESLEY GUILD HOSPITAL, ILESHA

TOPIC: BELL’S PALSY

PRESENTED TO : MR. IDOWU

t side resists closing.

se is unknown, but it's believed to be the result of swelling and inflammatio

a reaction that occurs after a viral infection.

• For most people, Bell's palsy is temporary. Symptoms us

 Are pregnant, especially during the third trimester, or wh

 Have an upper respiratory infection, such as the flu or a

 Increased sensitivity to sound on the affected side

 A decrease in your ability to taste

 Changes in the amount of tears and saliva you produce

 Irreversible damage to your facial nerve

 Misdirected regrowth of nerve fibers, resulting in involuntary contraction

 Imaging scans. Magnetic resonance imaging (MRI) or computerized

 However, despite this, valacyclovir (Valtrex) is sometimes given in combination

 Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin

 Applying moist heat. Putting a washcloth soaked in warm water on your

 Biofeedback training. By teaching you to use your thoughts to control your

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