Bell’s Palsy

Bell’s Palsy 

• Acute, usually temporary facial paresis (or palsy) from damage to facial nerve (CN VII); usually unilateral but can be bilateral

• Acute demyelination

Bell’s Palsy cause

• Exact cause unknown

  • Reactivation of herpes virus leading to inflammation and nerve compression causing clinical features

Bell’s Palsy symptoms onset

• Symptom onset is sudden; peak in 48 to 72 hours

• Prognosis—very good

• Recovery 2 weeks—6 months

• Some have residual effects

Bell’s Palsy

Bell’s Palsy – Clinical Manifestations

• CN VII: motor, sensory, and autonomic function

• Key feature: unilateral lower motor facial weakness

• 50% to 60% have pain behind the ear and neck

other clinical manifestations

• Other: drooping eyelid (ptosis) and corner of the mouth, facial twitching, dryness of eye or mouth, facial numbness, altered taste, hearing loss, excessive tearing in one eye

Bell’s Palsy quality of life

• Problems with eating, swallowing, taste, and speech

• Psychologic withdrawal due to changes in appearance, malnutrition, dehydration, mucous membrane trauma, corneal abrasions, muscle stretching, and facial spasms and contractures

diagnosis

• no definitive test, but to exclude other causes, CT scan

Interprofessional Care

• Symptom relief, prevent complications, protection of affected eye

• Oral corticosteroids: start within 72 hours

• Antivirals

• Eye protection

• Assure did not have a stroke

• Family and friend support very important

• Encourage social interaction

Pain management

• Mild analgesia

• Moist heat

• Electrical stimulation

• Facial massage and Facial muscles

• Physical therapy

• Sling can support affected muscles, improve lip alignment, and facilitate eating

• Protect face from cold to avoid trigeminal hyperesthesia (extreme sensitivity to pain or touch)

Exercises—

several times per day when function begins to return

eye protection

• Dark glasses: protection and cosmetic

  • Artificial tears: prevent drying of cornea

  • Ointment and eye shield at night; tape lids

  • Report eye pain, drainage, or discharge

Nutrition

• Chew on unaffected side

• Oral hygiene after meals

Physical appearance

• Can be devastating but good chance for full recovery

For a patient with Bell’s palsy, when are symptoms the most severe?

a. 12 hours after onset

b. 48 hours after onset

c. 96 hours after onset

d. 1 week after onset