Facial palsy
and Bells
palsy
AKSHAY RAJEEV
INTRODUCTION
FACIAL NERVE
Facial nerve is the nerve of the second branchial arch.
course and relation
Facial palsy:
It is a form of facial paralysis resulting from dysfunction of the
VII cranial nerve that results in the inability to control facial
muscles on the affected side.
* Palsy:
Complete or partial muscle paralysis, often accompanied by loss
of sensation and uncontrollable body movements or tremors.
→ Paralysis:
Complete loss of muscle function.
History
•The Persian physician Muhammad ibn Zakariya al-Razi (865–
925) detailed
the first known description of peripheral and central facial palsy.
•James Douglas (1675–1742) and Nicolaus Anton Friedreich
(1761–1836) also described it.
•Sir Charles Bell, for whom the condition is named,
presented three cases at the Royal Society of London in 1829.
BELLS PALSY
Most common form of unilateral isolated lower motor neuron
type of facial paralysis is Bell's palsy.
Pathophysiology
• Main cause of Bell's palsy is thought
to be latent herpes viruses (herpes
simplex virus type 1 and herpes zoster
virus), which are reactivated from
cranial nerve ganglia. It causes swelling
of nerve within the tight petrous bone
facial canal.
•Herpes zoster virus shows more aggressive biological behavior
than herpes simplex virus type 1.
•Polymerase chain reaction (PCR) techniques have isolated
herpes virus DNA from the facial nerve during acute palsy.
• Inflammation of the nerve initially results in a reversible
neuropraxia
Clinical manifestations
• Racer :Slightly higher in persons of Japanese descent. Familial
incident 4.1%
•Age and gender: Highest in persons aged 15-45 years. It is
rare below the age of 15 and above the age of 60. No gender
difference exists.
• Onset is fairly abrupt, with pain around the ear preceding the
unilateral facial weakness (maximum weakness by 48 hours).
Patients often describe the face as "numb" and sometimes give
the history of exposure to cold.
•Associated symptoms: Hyperacusis, the decreased production of
tears and saliva, and altered taste, otalgia or aural fullness and
facial or rectroauricular pain.
•Less common in pregnancy but prognosis is significantly worse in
pregnant women.
EXAMINATION
Examination Shows features of isolated lower motor neuron
facial paralysis. On the affected side following features are
observed. These include:
•Paralysis of all the muscles of facial expression. Dropping of
corner of mouth, effacement of creases and skin fold.
•Involvement of frontalis makes frowning difficult. Eye closure is
weak because of involvement of orbicularis oculi
•Drooling of saliva from angle of mouth.
•Action of the levator anguli oris on the normal side, makes the
angle of mouth to deviate to the opposite side of the lesion,
when the patient shows his teeth.
•When the closure of the eyelid is attempted, the eye on the
paralyzed side rolls upward (Bell's phenomenon)
•Due to exposure of the cornea, patient may develop exposure
keratitis and corneal ulceration.
Investigation
•No specific confirmatory diagnostic test.
•CSF may show mild lymphocytosis.
•MRI may reveal swelling and uniform enhancement of the
geniculate ganglion and facial nerve and in some cases,
entrapment of the swollen nerve in the temporal bone.
Treatment
• Severe facial weakness may produce inability to blink and lead
to exposure keratitis. Use of lubricating eye drops may be
needed, and paper tape to close the eye during sleep.
• Massage of weekend muscles.
Medical treatment of Bell's palsy:
•Steroids (Prednisolone) 1 mg/kg/day for 5-7 days and then
tapered over the next 1 week.
•Antiviral agents: for 5-7 days.
Famciclovir 500 mg BD.
Valacyclovir 500 mg BD.
- Acyclovir 800 mg five times a day.
• Surgical decompression-only if no resolution of symptoms after
2 weeks.
SUMMARY
•Facial nerve anatomy
•Facial palsy and causes
•History
•Bells palsy
•Pathophysiology and clinical
manifestation
•Examination and Investigation
•Difference between UMN and
LMN facial palsy
•Treatment
