BELL’S PALSYBell’s Palsy (facial paralysis) is due to peripheral involvement of the seventh cranialnerve on one side, which results in weakness or paralysis of the facial muscles. The causeis unknown, but possible cause may include vascular ischemia, viral disease (herpessimplex, herpes zoster), autoimmune disease, or a combination. Bell’s palsy mayrepresent a type of pressure paralysis in which ischemic necrosis of the facial nervecauses a distortion of the face, increased lacrimation (tearing), and painful sensations inthe face, behind the ear, and in the eye. The patient may experience speech difficultiesand may be unable to eat on the affected side owing to weakness.MEDICAL MANAGEMENTThe objectives of management are to maintain facial muscle tone and to prevent or minimize denervation. Steroidal therapy may be initiated to reduce inflammation andedema, which reduces vascular compression and permits restoration of blood circulationto the nerve. Early administration of corticosteroids appears to diminish severity, relieve pain, and minimize denervation. Facial pain is controlled with analgesic agents or heatapplied to the involved side of the face. Additional modalities may include electricalstimulation applied to the face to prevent muscle atrophy, or surgical exploration of thefacial nerve. Surgery may be performed if a tumor is suspected, for surgicaldecompression of the facial nerve, and for surgical rehabilitation of a paralyzed face. NURSING MANAGEMENTPatients need reassurance that a stroke has not occurred and that spontaneous recoveryoccurs within 3 to 5 weeks in most patients. Teaching patients with Bell’s palsy to carefor themselves at home is an important nursing priority.TEACHING EYE CAREBecause the blink reflex is diminished, the involved eye may not close completely andthe needs to be protected to prevent corneal irritation and ulceration. Inform the patient of potential complications, including corneal irritation and ulceration, overflow of tears, andabsence of blink reflex. Key teaching points include:· Cover the eye with a protective shield at night.· Apply eye ointment to keep eyelids closed during sleep.· Close the paralyzed eyelid manually before going to sleep.· Wear wrap-around sunglasses or goggles to decrease normal evaporation from the eye.TEACHING ABOUT MAINTAINING MUSCLE TONE· Show patient how to perform facial massage which gentle upward motion several timesdaily when the patient can tolerate the massage.· Demonstrate the facial exercises, such as wrinkling the forehead, blowing out thecheeks, and whistling in an effort to prevent muscle atrophy.· Instruct patient to avoid exposing the face to cold and drafts.