Bell·s Palsy

Presented by: Angelie Elvambuena Marie Rose Villeza Angelo Garcia Wilson Tobias

eating and closing of the eyelids. and the cause is unknown.Introduction Bell's palsy is a condition in which there is paralysis of the muscles of the face. frowning. It can also affect your ability to taste. typically on one side. It comes on suddenly. In Bell's palsy this nerve is affected. . In the UK it affects approximately 1 in 70 people at some point in their lifetime. It is usually temporary with most people making a full recovery within 2-3 months. leading to weakness or paralysis of the muscles that control smiling. Bell's palsy can affect men and women of any age although the highest incidence appears to be in 15-45 year olds. The facial nerve (seventh cranial nerve) supplies the muscles in your face.

definition Bell's palsy is a facial paralysis caused by an irritation of cranial nerve VII (seven) with no apparent cause. The nerve also controls the function of certain salivary glands and the lacrimal (tear) glands as well as the tiny muscles inside the ear that dampen loud noises. Cranial nerve VII controls most facial muscles. This excludes facial paralysis associated with known causes such as infection or stroke. and wrinkle the forehead. blink. including those needed to smile. .

‡ Overflow of tears down the cheek from keratitis caused by drying of cornea and lack of blink reflex. ‡ Decreased tear production that may predispose to infection. ‡ Speech difficulty secondary to facial paralysis. ‡ Numbness of face and tongue. .Signs and symptoms ‡ Distortion of face.

resulting in ischemia and paresis. but the mechanism is presumably swelling of the 7th cranial (facial) nerve due to an immune or viral disorder. Recent evidence suggests herpes simplex virus infection.Etiology Cause is unknown. . because the nerve passes through a narrow opening (internal acoustic meatus) in the temporal bone. The nerve is compressed.

peripheral) but much less so when the lesion is proximal to the nucleus (ie. Thus. distal to the 7th cranial nerve nuclei.The orbicularis oculi and frontalis muscles are paretic when the lesion is distal to the 7th cranial nerve nucleus (ie. In contrast. the muscles are paretic regardless of the location of the lesion along the 7th cranial nerve. the lower facial muscles (below the zygomatic arch) receive input from mainly the peripheral part of the facial nerve. The effects differ because the orbicularis oculi and frontalis muscles are controlled by the 7th cranial nerve nuclei (central part of the facial nerve). central). which receives input from only one hemisphere. which receive input from both left and right hemispheres. .

such as HIV. Women who are pregnant have a 3. Patients who have diabetes are more than 4 times as likely to develop the disorder as the general population.Risk factors Conditions that compromise the immune system. . increase the risk for Bell's palsy. Bell's palsy occurs most often in the third trimester.3 times higher risk for Bell's palsy than women who are not pregnant. During pregnancy.

Anatomy and Physiology .

The facial nerve (or seventh cranial nerve. fifth. Some anatomists identify the "muscles of facial expression" as those innervated by the facial nerve. orbital muscles partly innervated by CN III. but psychologically. eye muscles innervated by third. jaw muscles innervated by the trigeminal nerve (fifth cranial nerve). CN VII) carries the signals that control the movements of the facial muscles. fourth. which are the most significant of the muscles that produce facial expressions. . and sixth cranial nerves. and some other relatively minor motor connections of cervical nerves to muscles affecting facial appearance also play a role in production of facial expressions.

The motor nucleus of the facial nerve is located in the ventrolateral part of the reticular formation of the pons near its caudal border. often called the ascending part of the facial nerve. directed dorsomedially through the reticular formation. Its constituent cells are arranged so as to form a varying number of subgroups which may possibly be concerned with the innervation of individual facial muscles. This ascends along the medial longitudinal bundle for a considerable distance (5 mm). . Beneath the floor of the fourth ventricle the fibers turn sharply rostrad and are assembled into a compact strand of longitudinal fibers. From the dorsal aspect of this nucleus there emerge a large number of fine bundles of fibers. These rather widely separated bundles constitute the first part of the root of the facial nerve.

including the asceding part of the facial nerve. and helps to form the elevation in the rhomboid fossa. passing close to the lateral side of its own nucleus. and joins the inner angle of the geniculate ganglion. Beyond he ganglion its fibres are generally regarded as forming the chorda tympani. The facial nerve. and the pars intermedia is placed between the two. passes forward and outward upon the middle peduncle of the cerebellum. Occasionally a few of its fibres pass into the auditory nerve. Within the meatus the facial nerve lies in a groove along the upper and anterior part of the auditory nerve. The second part of the root of the facial nerve is directed ventrolaterally and at the same time somewhat caudally. firmer. to make its exit from the lateral part of the caudal border of the pons. and enters the internal auditory meatus with the auditory nerve. is known as the genu. rounder. This bend around the abducens nucleus. known as the facial colliculus. and smaller than the auditory. .The nerve then turns sharpy lateralward over the dorsal surface of the nucleus of the abducens nerve.

At the point where it changes its direction. it is at first directed outward between the cochlea and vestibule toward the inner wall of the tympanum. or geniculate ganglion). and divides behind the ramus of the lower jaw into two primary branches. supplying the superficial muscles in these regions. it presents a reddish gangliform swelling (intumescentia ganglioformis. and upper part of the neck. from its commencement at the internal meatus. to its termination at the stylo-mastoid foramen. . On emerging from the stylomastoid foramen it runs forward in the substance of the parotid gland. and follows the course of that canal through the petrous portion of the temporal bone. the facial nerve enters the aquaeductus Fallopii. temporo-facial and cervico-facial from which numerous offsets are distributed over the side of the head. it then bends suddenly backward and arches downward behind the tympanum to the stylo-mastoid foramen. face.At the bottom of the meatus. crosses the external carotid artery.

Pathophysiology Non-modifiable Age (early to mid 40¶s) Gender modifiable Viral infection Tumors Injuries The facial nerve within the ear (temporal lobe) swells Pressure on the bony canal Weakness or paralysis of the facial muscle Ischemic necrosis of the facial nerve Distortion of the face Increase lacrimation (tearing) Painful sensation of the face. behind the ear. and in the eyes Unable to eat on the affected side .

Diagnostic Procedure ‡ ‡ ‡ ‡ Blood tests for sarcoidosis or Lyme disease Magnetic resonance imaging (MRI) Electromyography (EMG) Nerve conduction test .

) ‡ Provide for pain relief with analgesics and local application of heat. >Decompression of facial nerve. (May reduce inflammation and edema and restore normal blood circulation to the nerve. >Surgical correction of eyelid deformities. as ordered. . ‡ Surgical intervention may be necessary.Medical management ‡ Administer steroid therapy. ‡ Facial massage may be prescribed to help maintain muscle tone.

Nursing Care Plan .

ofsunscreen and wear protective Clothing. V/S taken as follows: T: 37. Absence of situation. Cause fatigue. image.pano nako haharap sa mga tao nito?µ as verbalized by the patient. Speech difficulty Intentional hiding of the affected body parts. Objective data: Distortion of face. rest and appearance Intentional affected body by: hiding of the Relaxation Technique. current parts. .2 P: 90 R: 19 BP: 110/80 Diagnosis Disturbed body image related to physical changes due to current illness as manifested by: Distortion of face Speech difficulty Planning Intervention Rationale Evaluation After 30 mins Independent: After 30 of nursing >Discuss the patophysiology >to prevent fear of mins of intervention nursing of present situation unknown and to patient will be intervention affecting the individual understand his present able to patient >Encourage the client to situation. Acceptance of affected affected body >Teach the patient >To provide emotional body parts. relaxation techniques such support condition. >To reduce the chance of Exacerbations. body parts relaxation and imagery. incorporate self in current acceptance situation. >Able to as deep breathing. As of self in >Help client to select changes into body manifested by: current clothes. >To prevent oral look affected progressive muscle Ulcer. exercise . >Absence of affected body Able to look >Stay with the patient general health and intentional parts. >To reduce >Acceptanc > Avoid direct exposure to emotional e of current sunlight and encourage use stress that may condition. > Encourage good >To minimize body intentional As nutrition. affected body Hiding of > Encourage good Oral help prevent the Refused to look parts hygiene. >To improve parts. Refused to look affected body parts.Assessments Subjective data: ´Nakangiwi ang mukha ko. verbalize able to look and touch the >To begin to acceptance of verbalized affected body parts. sleep changes and Hiding of the manifested habits. Infection.

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