BELL’S PALSY

Facial nerve

* CN 7
* Somatic fibers: Skin of the EXTERNAL EAR
* Sensory (Special): Taste from ant. 2/3 of the tongue
* Motor fibers: Mm of facial expression, Stapedius, post belly of digastric mm
* Parasympathetic: Lacrimal, Sublingual, Submandibular, Minor salivary, Mucous glands of oral and nasal cavity;
* others: partly subserves parotid gland

BELL’S PALSY

* aka FACIAL NERVE PARALYSIS or IDIOPATHIC FACIAL NERVE PARALYSIS
* most common pathologic condition involving cranial nerve VII.
* most affected CN bcoz superficially located
* Considered LMNL
* affects mm funx: orbicularis oculi, risorious, corrugator supercilii

Bell’s palsy: Etiology

* unknown/ idiopathic
* Well accepted reason: VIRAL EXPOSURE or prob along the PATHWAY
* Others: Prolonged exposure to dec temp —> dec blood flow (vasoconstriction) —> ischemia —> palsy

Bell’s Palsy: Manifestation

1. Hemifacial Paralysis (most obv)
2. Crocodile tears
3. Salivary glands: underproduction/overproduction
4. Hyperacusis
5. Difficulty in smiling

Nuclei of facial nerve: location

* below the pons / pontine level
* considered = LMNL

Incidence: Bell’s

* Most common age = 10-40 yrs old
* curve = middle aged (25-40yrs old)
* 20 cases per 100,00

Specific Etiologic Cause:

1. Viral infections


1. HSV (Herpes Simplex Virus)
2. Epstein-Barr Virus
3. Varicella Zoster Virus
4. Intranasal inactivated influenza vaccine
2. Bacteria


1. Borrelia Burdorferi
3. Anatomic


1. Small sytlomastoid foramen d/t:


1. Edema
2. Otitis Media
3. Swelling of inner ear d/t infection
4. Gestational diabetes
5. Any cond that can lead to ischemia


1. Traumatic, non, secondary to viral exposure

Can impair neural conduction:

1. Inflammation
2. Demyelinating (dec nutrient and o2)
3. Ischemic
4. Compressive forces

Facial nerve: Structures passed thru

1. Stylomastoid foramen
2. Chora Tympani
3. Stapedius
4. Geniculate Ganglion
5. Internal Auditory Meatus
6. Pons

Manifestations: STYLOMASTOID FORAMEN (4)

* Level 1 lesion
* Facial asymmetry
* Outpouching (accumulation of saliva)
* Drooling of saliva on affected side
* Doll’s eye phenomenon

Doll’s eye phenomenon

upward rolling of the eyeball upon attempted eye closure; stylomastoid foramen

Manifestations: CHORDA TYMPANI

* lvl 2 lesion
* dryness of mouth
* loss of taste sensation of the ant. 2/3 of the tongue

Manifestations: Stapedius

* lvl 3 lesion
* Hyperacusis

Hyperacusis

inc sensitivity to sound; Stapedius mm

Manifestation: Geniculate Ganglion

* lvl 4 lesion
* d/t RAMSAY HUNT SYNDROME
* Exposure to varicella zoster, **increases affinity** on geniculate ganglion where the **synapse of the facial nerve is located.**

Manifestations: INTERNAL AUDITORY MEATUS

* lvl 5 lesion
* Sensorineural deafness

Sensorineural deafness

results from **damage to the hair cells** **within the inner ear**, the **vestibulocochlear nerve,** or the **brain's central processing centers**

Manifestations: PONS

* lvl 6 lesion
* highest lvl of lesion
* PATHOLOGIC REFLEX

GENERAL MANIFESTATION (4)

1. FACIAL SYNKINESIS
2. EIPIPHORA / CROCODILE TEARS
3. PSEUDOPTOSIS
4. LAGOPTHALMOS

FACIAL SYNKINESIS

* common consequence of Bell’s palsy d/t aberrant regeneration of the facial nerve


* **twitching/fasciculation of face**
* “Bell’s Palsy is self limiting”

EIPIPHORA

* crocodile tears
* d/t problem with the lacrimal glands
* the leaking of tears while eating or drinking in Bell palsy patients
* gustatory lacrimation

Pseudoptosis

Involves the reduction in the opening of the upper eyelid

Lagopthalmos

* incomplete eye closure

Specific Manifestations

* Facial nerve: sensory and motor impairment
* Pt may c/o
* Dysgeusia
* Ageusia
* Hyperacusis
* Bell’s Phenomenon (Doll’s eye)
* Marcus-Gunn Phenomenon
* Marin-Amat Phenomenon

Dysgeusia

Impairment of taste

Ageusia

loss of taste

Hyperacusis

inc sensitivity to sound

Marcus Gunn Phenomenon

* pontine lvl
* **Involuntary eye opening** upon attempted **lateral deviation of the jaw**

Marin-Amat Phenomenon

* pontine lvl
* EYE CLOSURE upon attempted mouth opening or deviation of the jaw on one side

DIAGNOSIS CRITERIA

* There is a diffuse facial nerve involvement manifested by paralysis of the facial muscles,
* with or without loss of taste on the anterior two-thirds of the tongue or
* altered secretion of the lacrimal and salivary glands

BELL’S PALSY: timeline

* Acute = 1-2 days
* within 3 weeks or less = reach max weakness/paralysis
* Complete recovery = 6 months
* Prodrome(early) symptom = ear pain, dysacusis

RED FLAGS

1. Bilateral BP
2. Recurrent BP
3. Assocation c rash elsewhere or with feeling generally unwell (SARCOID OR LYME DSE)
4. Previous episode = demyelination

TREATMENT

1. Medications


1. Corticosteriod = prednisone, prednisolone
2. Vit. B
2. Physical Therapy


1. IRR (Luminous IRR)
2. ES
3. Exercises


1. PNF/Facial nerve exercises
2. Candle blowing exercises