BELL'S PALSY

Bell’s palsy is a facial paralysis of acute onset presumed to be due to non-suppurative inflammation of unknown etiology of the facial nerve within its  canal above the stylomastoid foramen. 

CAUSES: 

History of exposure of     the year to extreme cold Water retention in     pregnancy  Infection of the ear Herpes zoster infection Upper respiratory tract     infection Idiopathic They all causes facial   nerve lesion.It occurs any time from infancy to old age. However it is more seen among younger population and males are more affected than females.  

MANAGEMENT FOR BELL’S PALSY:

 Resolving the inflammation:     

If the patient comes immediately following the onset of paralysis, then he     may be treated with either SWD or IR to increase the circulation in the     stylomastoid  foramen so that the inflammation can be resolved. If the     paralysis is only due to compression or neuropraxia then the patient will     show a miraculous recovery once the inflammation is resolved and   compression on the nerve is relieve. Such heat modalities can be tried for   a period of one week to ten days.

 Maintenance of muscle     properties: This can be achieved with interrupted galvanic stimulation to     the paralyzed muscles.  

Facial massage: Massage is essential to     maintain the circulation to the face as well as to keep the face supple.     The direction of the manipulation used should be in upward direction and     not downward direction as downward movement tends to stretch the paralyzed     muscle more and can have deleterious effect. 

Taping or Splinting:     These methods are used to decrease the facial asymmetry noticed in Bell’s   palsy. 

Eye care: the patient     may be instructed to wear protective goggles to prevent entry of foreign   bodies into his eyes. 

Continuous monitoring:     the patient recovery status should be reviewed consistently.  SDC is     helpful in knowing the prognosis of the patient. 

Faradic Reeducation:     only if patient can tolerate sensory stimulus of faradic current to the    face, faradic reeducation is given. Other means of reeducating the  movement is by using 

PNF techniques, visual feedback exercises etc. 

Visual feedback   exercises: the patient may asked to do facial exercises in front of the     mirror, so that he gets a visual feedback and can perform the exercises     more efficiently.

 Strengthening   exercises: once the facial muscles reach grade 3 or fair then resistance     can be given to muscle action to further strengthen them.