Bell’s Palsy

BELL’S
PALSY
T.O AVWIORO
Introduction
• Bell's Palsy is a condition characterized by the sudden onset of facial paralysis or
weakness due to inflammation of the facial nerve (cranial nerve VII).
• It can affect one side of the face, leading to difficulties with facial expressions,
and may also result in other symptoms.
• The exact cause of Bell's Palsy is often unknown, but it is believed to be
associated with viral infections.
• There is sudden weakness in the muscles on one side of the face.
• The weakness is short-term and improves over weeks.
• The weakness makes half of the face appear to droop
Etiology
• While the precise cause of Bell's Palsy is not fully understood, several factors and
associations have been identified:
• Viral Infections: The condition is often linked to viral infections, particularly:
• Herpes Simplex Virus (HSV): The virus responsible for cold sores is a common
trigger.
• Other potential viruses include:
• Varicella-Zoster Virus (chickenpox and shingles)
• Epstein-Barr Virus (EBV)
• Cytomegalovirus (CMV)
• Influenza Virus
• Adenovirus
Etiology
• Immune Response: An abnormal immune response to a viral infection may lead

to inflammation of the facial nerve.
• Environmental Factors: Cold weather, stress, and pregnancy may increase
susceptibility, although evidence is not definitive.
Pathophysiology
• BELL: derived from Sir Charles Bells

• PALSY: means muscle paralysis
• It is idiopathic, but it is mostly caused by vasospasm along the 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 about 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.
Clinical Presentation
• Facial Weakness: One-sided facial drooping, making it difficult to close the eye,
smile, or raise the eyebrow on the affected side.
• Loss of Sensation: Altered taste perception or loss of taste on the anterior two-
thirds of the tongue on the affected side.
• Eye Symptoms: Increased tearing or dryness due to inability to blink fully, leading
to potential exposure keratitis.
• Pain: Discomfort or pain around the jaw or behind the ear on the affected side,
often preceding the facial weakness.
• Tinnitus: Ringing in the ears or hypersensitivity to sound (hyperacusis).
• Salivation Changes: Altered production of saliva.
Clinical Presentation
• 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
Diagnosis
• Diagnosis of Bell's Palsy is primarily clinical and involves the following:

• Clinical Evaluation: Physicians assess the patient's symptoms, medical history,
and a neurological examination to rule out other causes of facial weakness.
• Exclusion of Other Conditions: Other conditions that may cause facial paralysis,
such as:
• Stroke
• Tumors
• Lyme disease
• Multiple sclerosis
• Ramsay Hunt Syndrome (herpes zoster affecting the facial nerve)
Diagnosis
• Imaging Studies:
• MRI or CT Scans: May be performed in atypical cases or to rule out other
conditions, especially if the weakness is accompanied by additional
neurological symptoms.
Management and Treatment
• While Bell's Palsy often resolves spontaneously, management focuses on

alleviating symptoms and enhancing recovery:
• Medications:
• Corticosteroids: Prednisone is commonly prescribed to reduce inflammation and edema
of the facial nerve, particularly if started within 72 hours of symptom onset.
• Analgesics: Pain relievers such as acetaminophen or NSAIDs may help alleviate
discomfort.
• Antivirals: Sometimes prescribed in conjunction with corticosteroids, especially if a
herpes virus is suspected, although their benefit is debated.
• Physical Therapy:
• Facial exercises may help improve muscle strength and coordination.
• Gentle massage and electrical stimulation can be beneficial.
Management and Treatment
• Eye Care:
• Protecting the eye on the affected side is crucial to prevent corneal damage:
• Use of lubricating eye drops or ointments.
• Wearing an eye patch at night may help prevent dryness and irritation.
• Supportive Care:
• Education about the condition, including reassurance about the generally
favorable prognosis, is essential for psychological support.
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
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.
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 evaporation 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 structure and function for
vision evidenced by facial edema
• Disturbed sensory perception related to alteration in structure and function
for vision evidenced by painful sensation of the face
Prognosis
• The prognosis for Bell's Palsy is generally favorable, with many patients
experiencing significant recovery within three to six months. Approximately 70-
85% of individuals recover completely.
• Factors influencing recovery include the severity of initial symptoms and the
promptness of treatment.
• Some patients may experience residual weakness or other long-term effects, but
these are relatively uncommon.
Complications
• Permanent Facial Weakness: A small percentage may experience lasting

weakness or asymmetry.
• Synkinesis: Involuntary movements, such as facial spasms, where movements in
one part of the face are triggered by movement in another (e.g., closing the eyes
causes the mouth to twitch).
• Chronic Pain: Some patients may develop persistent pain or discomfort in the
affected area.
• Corneal Damage: Incomplete eyelid closure may lead to corneal abrasions or
infections.

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BELL’S

• Immune Response: An abnormal immune response to a viral infection may lead

• BELL: derived from Sir Charles Bells

• Diagnosis of Bell's Palsy is primarily clinical and involves the following:

• While Bell's Palsy often resolves spontaneously, management focuses on

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

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

• Permanent Facial Weakness: A small percentage may experience lasting

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