Bell

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Bells Palsy

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Bells Palsy

• Characterized by
• Peripheral facial paralysis
• Acute benign cranial polyneuritis
• Acute disorder characterized by a disruption of
  the motor branches of cranial nerve VII on one
  side of the face. (in absence of stroke)

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Bells Palsy

• Can affect any age group, though more common from
  20-60.
• Etiology unknown though reactivated herpes
  simplex may be involved.

• Reactivation causes edema, inflammation,
  ischemia, and eventual demyelination of the
  nerve, creating pain and alteration in motor and
  sensory function.

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Clinical manifestations

• Benign, with 85 of people recovering in 6
  months-remaining 15 have some asymmetry of
  facial muscles

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Clinical manifestations

• Often accompanied by an outbreak of herpes
  vesicles in or around the ear.
• Pain around or behind the ear
• Fever, tinnitus, hearing deficits
• Flaccidity of the affected side of the face with
  drooping of the mouth accompanied by drooling DT
  paralysis of the facial nerve (motor branches)

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Clinical manifestations

• Inability to close the eyelids, with an upward
  movement of the eyeball when closure is
  attempted lower lid may turn out
• Wide palpebral fissure (opening between eyelids)
• Flattening of the nasolabial fold
• Inability to smile, frown, or whistle
• Unilateral loss of taste
• Altered chewing ability loss of or excessive
  tearing

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Complications

• Psychological withdrawal DT changes in
  appearance,malnutrition or dehydration, mucous
  membrane trauma, corneal abrasion, muscle
  stretching, and facial spasms and contractures.

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Diagnostic Studies

• Diagnosis made on basis of symptoms in the
  absence of other causes of paralysis such as
  stroke.
• No definitive test
• EMG may determine nerve excitability or absence

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Therapeutic Management

• Corticosteroids- drug of choice
• Prednisone may be started immediately!
• Best if initiated before paralysis is complete
• Taper off over 2 weeks
• Decrease edema and pain
• Analgesics may be needed for pain
• Antivirals Acyclovir (Zovirax) and Famvir
  because HSV is implicated in 70 of cases.
• See Lewis 1719-1720- Nursing Implementation