BELL’S PALSY

Dokter Pembimbing:
dr. Liza Chairani, Sp. A, M.Kes

NOVITA INDAH YANTI

712018037
background
Bell's Palsy was first described in 1821
by an anatomist and surgeon named Sir
Charles Bell. Bell's palsy is acute
weakness or facial peripheral nerve
palsy (acute onset) on the side of the
face.
Bell's palsy is the most common case of
unilateral facial peripheral acute paralysis in the
world. The incidence is 20-30 cases out of
100,000 people. Bell's palsy accounts for a
portion of 60-70% of all unilateral facial
peripheral paralysis cases.
Bell's palsy is rarely found in children <2 years
old. There is no difference on the right and left
sides of the face. Sometimes bilateral facial
nerve paralysis can occur with a prevalence of
0.3-2%.
Theoretical basis
DEFINITION

• Bell's palsy is an acute weakness or

paralysis of the facial peripheral nerve
(facial nerve) on the side of the face. This
condition causes the inability of the patient
to move half of his face consciously
(voluntarily) on the affected side

Bells Palsy is an acute, unilateral, peripheral

and lower motor neuron disease (LMN).
 EPIDEMIOLOGY

• Bell's palsy is the most common facial nerve disease.

Bell’s Palsy prevalence in some countries is quite high.
• Bells Palsy is less common at the age of 65 years, of
100,000 people found 59 cases of Bells Palsy. The
incidence of Bells Palsy is lowest in children younger
than 10 years and is highest at age 60 years or older.
• The age most at risk for Bells Palsy is between 20 and
40 years.
 ETIOLOGY

The most common etiology of Bell's palsy is a virus

infection. The exact mechanism that occurs due to this
infection that causes the disease is unknown. Inflammation
and edema are thought to occur due to infection. The facial
nerve that runs through a narrow tunnel becomes squashed
because of this edema and causes nerve damage both
temporarily and permanently. The virus that causes this
infection is thought to be herpes simplex.
 ANATOMY

The facial nerve has a nucleus located inside the medulla

oblongata. The facial nerve has motor nerve roots that serve
special mimic and sensory roots (nervus intermedius). This
nerve appears on the anterior surface between the pons and
medulla oblongata (pontocerebellar angles). The nerve root
runs along the vestibulo-cochlear nerve and into the internal
acoustic meatus in the petrous joint of the temporal bone.
The nerve enters the facial canal at the base of the meatus and turns
dorsolaterally. The nerve goes to the medial wall of the tympanic
cavity and forms an angle above the promontorium called the
ganglion geniculatum. The nerves then travel down the dorsal wall
of the tympanic cavity and out of the temporal os through the
stylomastoid foramen. The nerve continues to pass through the
parotid gland to provide innervation to the mimic muscles.
 PATOFISIOLOGY

The pathophysiology is unclear, but one theory mentions the

occurrence of an inflammatory process in the facial nerve  an
increase in the diameter of the facial nerve resulting in compression of
the nerve through the temporal bone. The journey of the facial nerve
comes out of the temporal bone through the facial canal which has a
funnel-like shape which narrows to the exit as a mental foramen 
motor impulses delivered by the facial nerve can get disturbances in
the supranuclear, nuclear and infranuclear pathways.
Based on other studies, the main cause of Bell's palsy is
reactivation of the herpes virus (HSV type 1 and herpes zoster
virus) which attacks the cranial nerves. Especially the herpes
zoster virus because this virus spreads to nerves through
satellite cells. In inflammation of herpes zoster in the ganglion
geniculatum, the facial nerve can be involved, giving rise to
LMN facial paralysis.
 Manifestation

The clinical manifestations of Bell's palsy can differ depending on the

lesion on facial nerve travel. If the lesion is in the stylomastoid
foramen, a complete disturbance can occur which causes paralysis of
all muscles of facial expression. When closing the eyelid, both eyes
make an upward rotation (Bell 's phenomenon). In addition, the eyes
can feel runny because the flow of tears to the lacrimal sac, which is
aided by the orbicularis oculi muscle is impaired.
 Different Diagnose

The differential diagnosis of facial paralysis can be divided according to the

location of central and peripheral lesions. Central abnormalities can be
strokes if accompanied by weakness of the same side limb and pathological
processes found in the contralateral cerebral hemisphere; tumor
abnormalities when gradual onset and mental changes in status or history of
cancer in other body parts; multiple sclerosis when accompanied by other
neurological disorders such as hemiparesis or optic neuritis; and trauma if
there is a fracture of the temporal os in petrosus, the cranial base, or a history
of previous trauma.
 Diagnostic

History and physical examination are the most vital things in the
diagnosis of patients with Bell's palsy. Most cases are
idiopathic. The use of diagnostic imaging is not recommended
when the patient first arrives. MRI (magnetic resonance
imaging) may show enlargement of the facial nerve, especially
in the area of the ganglion geniculi.
 Therapy

1. Rest especially in acute situations.

2. Medical (Anti-virus and prednisone)
3. Physiotherapy
4. Operation
 Complication
1. Incomplete motor regeneration, namely suboptimal
regeneration which causes paresis throughout or some
facial muscles.
2. Incomplete sensory regeneration that causes disgeusia
(taste disorder), ageusia (tasting loss), and dysesthesia
(impaired sensation or sensation that is not the same as
normal stimuli)
3. Incorrect reinervation of facial nerve.
 PROGNOSIS

The prognose is dubia ad Bonam.

conclution
Bell's palsy is acute weakness or facial peripheral nerve palsy (acute
onset) on the side of the face. Bell's palsy is an acute weakness or
paralysis of the facial peripheral nerve (facial nerve) on the side of the
face. This condition causes the inability of the patient to move half of
his face consciously (voluntarily) on the affected side
History and physical examination are the most vital things in
the diagnosis of patients with Bell's palsy. Most cases are
idiopathic. The use of diagnostic imaging is not
recommended when the patient first arrives. MRI (magnetic
resonance imaging) may show enlargement of the facial
nerve, especially in the area of the ganglion geniculi
The therapy that can be given to patients with Bell's Palsy
is resting during an acute attack, given drugs such as
prednisone, surgery and physiotherapy.
Thankyou :’)