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.