bell's palsy by akond

WELCOME TO MY PRESENTATION

Presentation on: Bell’s Palsy

Presented by :

Mahashin akond

BSc in physiotherapy

IHT.Dhaka.Bangladesh.

Bell’s palsy(Facial Nerve Palsy):

This is a condition in which there is a lesion of the facial nerve and resultant paralysis in the muscles that it supplies.

Reference:Tidys physiotherapy 12thedition

Facial nerve supply

View of Bell’s palsy:

Path way of facial nerve :

The main facial muscles affected are::

1. Occipitofrontalis ― Raises eyebrow.

2. Orbicularis oculi ― Closes eye.

3. Corrugator and procerus ― Wrinkle skin between eyebrows and frowns.

Reference: Tidys physiotherapy 12thedition

4.Zygomatic us major and minor, Levator anguli oris,levator labii superioriss-Raise the corner of the mouth and upper lip

5. Orbicularis oris - Closes the mouth.

6. Risorius ― Pulls the angle of the mouth back, as in grinning.

Reference: Tidys physiotherapy 12thedition

7. Buccinator - Keeps the cheek against the teeth during mastication or sucking.

Without it, food is trapped between the cheek and teeth which is functionally highly restricting.

Reference: Tidys physiotherapy 12thedition

8. Depressor anguli 0ris and depressor labii in ferioris ― Pull down the angle of the: mouth and the lower lip.

9. Mentalis ―- Wrinkles the chin and is very important in drinking because it holds the lower lip on the cup and prevents dribbling.

The nerve also supplies taste sensation to the palate and anterior two-thirds of the tongue and the parasympathetic supply to the secretomotor salivary glands.

Reference: Tidys physiotherapy 12thedition

Aetiology:

The cause is unknown. It can occur at any age and is not gender specific..

Onset:

This is often sudden. The patient may have a history of earache or of having been in a draught. Often the patient wakes up with the paralysis, having been perfectly normal the night before.

Reference: Tidys physiotherapy 12thedition

Pathology:

The facial nerve becomes swollen and hyperemic

within the facial canal. in which there is limited

space. The nerve rapidly becomes compressed and

conductivity is lost.

Reference: Tidys physiotherapy 12thedition

Prognosis:

Fifty per cent recover within 3 months. Clinical features ― on the side 0f the lesion

1. Loss of facial expression.

2. Drooping of the face - lower eyelid, eyebrow and

corner of the mouth sag.

3. Closing the eye is difficult.

Reference: Tidys physiotherapy 12thedition

Prognosis::

4. Eating is difficult because food collects in the side of the cheek and fluids seep out of the corner ofthe mouth.

5. Speaking, whistling and drinking are impaired.

6. Non-verbal communication is lost as the patient cannot register pleasure, laughter, surprisc,interest or worry.

7. The patient tends to sit with the hand over the side of the face.

Reference: Tidys physiotherapy 12thedition

Treatment:

Oral steroids may be given to reduce inflammation.

Surgery may be used in longstanding cases to

improve appearance. The eyelids may be stitched

together to protect the eye.

Reference: Tidys physiotherapy 12thedition

Physiotherapy:

During paralysis

1. Ultrasound given over the nerve trunk just in front of the tragus of the ear may reduce the Inflammation.

Reference: Tidys physiotherapy 12thedition

2.Massage may be taught to the patient:

(a) Stroking in an upward, outward direction.

During paralysis

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b) Slow finger kneading applied over the paralysed muscles maintains skin suppleness and muscle elasticity.

Reference: Tidys physiotherapy 12thedition

3.advice:

(a) The patient should lie down at intervals throughout the day to reduce the effects of gravity on the paralyzed muscles.

(b) The .eye should be bathed regularly because the normal blanking reflex is lost and dust particles collect, producing conjunctivitis .

Reference: Tidys physiotherapy 12thedition

Recovery stage:

Mild infra-red treatment may be applied to warm he muscles and improve function ― the eye must protected with wet cotton wool.

PNP techniques are used for re―education:

1. Quick stretch technique can be applied to regain raising of the eyebrow and the movements of the

corner of the mouth.

2.The physiotherapist can produce the movement passively then ask the patient to hold, then try to produce the movement.

3. Icing, brushing, tapping or brisk stroking may be applied along the length of the muscles, e.g. the zygomatics

Reference: Tidys physiotherapy 12thedition

Exercises:

1. Look surprised then frown.

2. Squeeze eyes closed then open wide.

3. Smile, grin, say ‘o’.

Reference: Tidys physiotherapy 12thedition

4. Say ‘a, e, i, 0, u'. -

5. Hold straw in mouth ― suck and blow.

6. Whistle-These exercises are performed in lying at first, then sitting up. The patient may assist at first then progress to resisting. A mirror is useful to enable the patient to observe the muscle activity.

Reference: Tidys physiotherapy 12thedition

Failure to recovery:

1. In a complete recovery, it persist 3 months.

2. we can also use electrical stimulation-pulse width 80s,frequence:5-8Hz,voltage 0-18V,program:2s on/2s off for 3-5h daily in two session.

3. Has been improve facial muscle.

Reference: Tidys physiotherapy 12thedition

Thanks' to all