Bell’s Palsy

Oleh : Amos Bagus

 Definition
• The bell’s palsy is definied as a facial paralysis of
acute onset attributed to a acute non-supportive
inflammation of facial nerve within stylomastoid
foramen. (Roger, 1984)
 Introduction
Charles Bell (1821) :
know for his studies on the
nervous system and the brain
 Etiology Theory
1. Theory of viral infection
• Evidence shows that reactivated herpes simplex virus
(HSV)
• Reactiviting of the HSV causes inflammation,
edema, ischemia
2. Theory ischemic
• Spasm arteriole or stasis vena
3. Hereditery Theory
• Narrow facial canal
 Pathology Process
• Presence of inflammation and swelling of
facial nerve
 Prognosis
About 80%of patient with bell’s palsy
have motor function recovery
completely within 6 month
Complete paralysis and severe pain in
early stage  poor prognosis
SDC or EMG shows nerve faces muscle
no total denervated  good
prognosis
 Diagnosis
• Will exam for upper and lower facial weakness
• SDC and EMG
• MRI and CT Scan
 Clinically facial nerve injury is classified
using the House-Brackmann system.

• Grade I is normal function.

• Grade II shows slight weakness but no synkinesis.
• Grade III shows obvious weakness with some mass
movement.
• Grade IV has inability to elevate the brow, significant
synkinesis, and obvious weakness.
• Grade V has barely perceptible motion, and
• Grade VI has no movement

Sinkinesis yaitu gerakan involunter yang mengikutigerakan volunter,

contohnya timbul gerakan elevasi involunter dari sudut mata, kontraksi
platysma
Corticobulbar Tract
 Examination
UMN : frontalis is spared allowing normal furrowing of brow
and eye blinking
LMN : all muscle of facial expression are affected
 Spesific Examination
• Ugo Fisch
• MMT facial muscle
 Intervensi
• Electrical Stimulation
• Massase
• Infrared
• Exercise
Find Differences
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