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Bell’s Palsy

Presented by:
Angelie Elvambuena
Marie Rose Villeza
Angelo Garcia
Wilson Tobias
Introduction
 Bell's palsy is a condition in which there is
paralysis of the muscles of the face, typically on one side.
It is usually temporary with most people making a full
recovery within 2-3 months. It comes on suddenly, and
the cause is unknown.
 The facial nerve (seventh cranial nerve) supplies
the muscles in your face. In Bell's palsy this nerve is
affected, leading to weakness or paralysis of the muscles
that control smiling, frowning, eating and closing of the
eyelids. It can also affect your ability to taste.
 Bell's palsy can affect men and women of any age
although the highest incidence appears to be in 15-45
year olds. In the UK it affects approximately 1 in 70
people at some point in their lifetime.

definition
 Bell's palsy is a facial paralysis caused by an
irritation of cranial nerve VII (seven) with no apparent
cause. This excludes facial paralysis associated with
known causes such as infection or stroke. Cranial nerve
VII controls most facial muscles, including those needed
to smile, blink, and wrinkle the forehead. The nerve also
controls the function of certain salivary glands and the
lacrimal (tear) glands as well as the tiny muscles inside
the ear that dampen loud noises.
Signs and symptoms
• Distortion of face.
• Numbness of face and tongue.
• Overflow of tears down the cheek from keratitis caused
by drying of cornea and lack of blink reflex.
• Decreased tear production that may predispose to
infection.
• Speech difficulty secondary to facial paralysis.

Etiology
 Cause is unknown, but the mechanism is
presumably swelling of the 7th cranial (facial)
nerve due to an immune or viral disorder.
Recent evidence suggests herpes simplex virus
infection. The nerve is compressed, resulting in
ischemia and paresis, because the nerve passes
through a narrow opening (internal acoustic
meatus) in the temporal bone.


 The orbicularis oculi and frontalis muscles are
paretic when the lesion is distal to the 7th cranial
nerve nucleus (ie, peripheral) but much less so when
the lesion is proximal to the nucleus (ie, central).
The effects differ because the orbicularis oculi and
frontalis muscles are controlled by the 7th cranial
nerve nuclei (central part of the facial nerve), which
receive input from both left and right hemispheres.
In contrast, the lower facial muscles (below the
zygomatic arch) receive input from mainly the
peripheral part of the facial nerve, distal to the 7th
cranial nerve nuclei, which receives input from only
one hemisphere. Thus, the muscles are paretic
regardless of the location of the lesion along the 7th
cranial nerve.

Risk factors
 Conditions that compromise the immune
system,such as HIV, increase the risk for Bell's
palsy. Patients who have diabetes are more than
4 times as likely to develop the disorder as the
general population. Women who are pregnant
have a 3.3 times higher risk for Bell's palsy than
women who are not pregnant. During
pregnancy, Bell's palsy occurs most often in the
third trimester.
Anatomy and Physiology
 The facial nerve (or seventh cranial nerve,
CN VII) carries the signals that control the movements
of the facial muscles, which are the most significant of
the muscles that produce facial expressions. Some
anatomists identify the "muscles of facial
expression" as those innervated by the facial nerve, but
psychologically, eye muscles innervated by third, fourth,
fifth, and sixth cranial nerves, orbital muscles partly
innervated by CN III, jaw muscles innervated by the
trigeminal nerve (fifth cranial nerve), and some other
relatively minor motor connections of cervical nerves to
muscles affecting facial appearance also play a role in
production of facial expressions.
 The motor nucleus of the facial nerve is
located in the ventrolateral part of the reticular
formation of the pons near its caudal border. Its
constituent cells are arranged so as to form a
varying number of sub-groups which may possibly
be concerned with the innervation of individual
facial muscles.
 From the dorsal aspect of this nucleus there
emerge a large number of fine bundles of fibers,
directed dorsomedially through the reticular
formation. These rather widely separated bundles
constitute the first part of the root of the facial
nerve. Beneath the floor of the fourth ventricle the
fibers turn sharply rostrad and are assembled into a
compact strand of longitudinal fibers, often called
the ascending part of the facial nerve. This ascends
along the medial longitudinal bundle for a
considerable distance (5 mm).


The nerve then turns sharpy lateralward over the
dorsal surface of the nucleus of the abducens nerve, and helps
to form the elevation in the rhomboid fossa, known as the
facial colliculus. This bend around the abducens nucleus,
including the asceding part of the facial nerve, is known as the
genu. The second part of the root of the facial nerve is directed
ventrolaterally and at the same time somewhat caudally,
passing close to the lateral side of its own nucleus, to make its
exit from the lateral part of the caudal border of the pons.
 The facial nerve, firmer, rounder, and smaller than the
auditory, passes forward and outward upon the middle
peduncle of the cerebellum, and enters the internal auditory
meatus with the auditory nerve. Within the meatus the facial
nerve lies in a groove along the upper and anterior part of the
auditory nerve, and the pars intermedia is placed between the
two, and joins the inner angle of the geniculate ganglion.
Occasionally a few of its fibres pass into the auditory nerve.
Beyond he ganglion its fibres are generally regarded as
forming the chorda tympani.

 At the bottom of the meatus, the facial nerve
enters the aquaeductus Fallopii, and follows the course
of that canal through the petrous portion of the temporal
bone, from its commencement at the internal meatus, to
its termination at the stylo-mastoid foramen. it is at first
directed outward between the cochlea and vestibule
toward the inner wall of the tympanum; it then bends
suddenly backward and arches downward behind the
tympanum to the stylo-mastoid foramen. At the point
where it changes its direction, it presents a reddish
gangliform swelling (intumescentia ganglioformis, or
geniculate ganglion). On emerging from the stylo-
mastoid foramen it runs forward in the substance of the
parotid gland, crosses the external carotid artery, and
divides behind the ramus of the lower jaw into two
primary branches, temporo-facial and cervico-facial
from which numerous offsets are distributed over the
side of the head, face, and upper part of the neck,
supplying the superficial muscles in these regions.
Pathophysiology
Non-modifiable modifiable
Age (early to mid 40’s) Viral infection
Gender Tumors
Injuries

The facial nerve within the ear (temporal lobe) swells

Pressure on the bony canal

Weakness or paralysis of the facial muscle

Ischemic necrosis of the facial nerve

Distortion of the face


Increase lacrimation (tearing) Unable toeyes
eat on the affected side
Painful sensation of the face, behind the ear, and in the
Diagnostic Procedure
• Blood tests for sarcoidosis or Lyme disease
• Magnetic resonance imaging (MRI)
• Electromyography (EMG)
• Nerve conduction test

Medical management
 Administer steroid therapy, as ordered. (May
reduce inflammation and edema and restore
normal blood circulation to the nerve.)
• Provide for pain relief with analgesics and local
application of heat.
• Facial massage may be prescribed to help
maintain muscle tone.
• Surgical intervention may be necessary.
 >Decompression of facial nerve.
 >Surgical correction of eyelid deformities.

Nursing Care Plan
Assessments Diagnosis Planning Intervention Rationale Evaluation
Subjective data: Disturbed body After 30 mins of Independent: After 30
“Nakangiwi ang image nursing >Discuss the >to prevent fear of minsof
mukha ko,pano nako related to intervention patophysiologyof present unknown and to nursing
haharap sa mga tao physical changes patient will be
situation affecting the understand his present intervention
nito?” as verbalized due to current able to patient able
by the patient. illness as verbalize individual situation. to verbalized
Objective data: manifested by: acceptance of >Encourage the client to >To begin to acceptance
Distortion of face. Distortion of self in current look and touch the affected incorporate of self in
Speech difficulty face situation. As body parts. changes into body current
Intentional hiding of Speech difficulty manifested by: >Help client to select image. situation. As
the affected body Absence of manifested
parts. Intentional hiding intentional
clothes. >To minimize body by:
Refused to look of the affected Hiding of the > Encourage good changes and >Absence of
affected body parts. body parts. affected body nutrition, sleep appearance intentional
V/S taken as parts. habits, exercise , rest and >To improve Hiding of the
follows: Refused to look Able to look Relaxation Technique. general health and affected
T: 37.2 affected body affected body >Stay with the patient
parts. help prevent Infection. body parts.
P: 90 parts >Able to look
R: 19 Acceptance of
> Encourage good Oral >To provide emotional affected
BP: 110/80 current hygiene. support body parts
condition. >Teach the patient >To prevent oral >Acceptance
relaxation techniques such Ulcer. of current
as deep breathing, >To reduce condition.
progressive muscle emotional
relaxation and imagery. stress that may
> Avoid direct exposure to Cause fatigue.
sunlight and encourage use >To reduce the
ofsunscreen and chance of
wear protective Exacerbations.
Clothing.

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