FACIAL - BELL'S PALSY
PHYSIOTHERAPY MANAGEMENT
FOR FACIAL NERVE PARALYSIS (BELL’S PALSY/ FACIAL PALSY)
Physiotherapy is beneficial to individuals with Bell’s palsy as it helps to maintain muscle tone and stimulate the facial nerve.
It is important that muscle re-education exercises and soft tissue techniques be implemented prior to recovery in order to help prevent permanent contractures of the paralyzed facial muscles.
Physiotherapy treatments includes
· Facial muscle stimulation
· Manual Massage
· Muscle reeducation exercise
· Kabat Rehabilitation
· Taping
· Independent home exercise program
· Eye care: The greatest danger of facial paralysis is possible eye damage. Facial paralysis often keeps one or both eyelids from closing fully. When the eye can’t blink normally, the cornea may dry out, and particles may enter and damage the eye.
Patients with facial paralysis should use artificial tears throughout the day and apply a lubricant at night. They may also need to wear a special clear plastic moisture chamber to keep the eye moist and protected.
Facial Muscles
FACIAL NERVE PARALYSIS (BELL’S PALSY/ FACIAL PALCY)
Facial paralysis or Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. During the physiotherapy physical examination, a distinction must first be made between paralysis and paresis (incomplete paralysis). It must also be determined whether the forehead is involved in the motor defect or not to determine motor neuron component (upper or lower). Several conditions can cause facial paralysis if no specific cause can be identified, the condition is known as Bell's palsy (Infranuclear lesions or lower motor neuron lesion of facial nerve).
Bell's palsy is the idiopathic unilateral facial nerve (vii cranial nerve) dysfunction that results in inability to control facial muscles. Previously considered idiopathic (unknown cause), it has been recently linked to viral infection. The hallmark of this condition is a rapid onset of partial or complete paralysis that often occurs overnight. In rare cases (<1%), it can occur both the side resulting in total facial paralysis.
Causes:
1) Idiopathic
2) Middle ear infection
3) Trauma
4) Tumors
5) Post acoustic neuromas surgery
6) During surgery injuries.
7) One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. Ramsey-Hunt syndrome (herpes zoster oticus).The major differences in this condition are the presence of small blisters, or vesicles, on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).
8) Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.
Signs and symptoms: Affected patient may have one or more symptoms listed as below . One sided facial droop that comes on within 72 hours (infranuclear/lower motor neuron type). Blinking and closing the eyes, smiling, frowning, lacrimation, salivation, flaring nostrils and raising eyebrows are affected. Over-sensitivity to certain frequency and volume ranges of sound (Hyperacusis) or loss of taste sensation in the anterior 2/3 of the tongue.
Although defined as a mononeuritis (involving only one nerve), patients diagnosed with Bell’s palsy may have "myriad neurological symptoms" facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesias, ipsilateral limb weakness, and a sense of clumsiness" that are "unexplained by facial nerve dysfunction" This is yet an enigmatic facet of this condition.
Physiotherapists should determine whether the forehead muscles are spared. Due to an anatomical peculiarity, forehead muscles receive innervations from both sides of the brain. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy)
Degree of nerve damage can be assessed by the medical practitioner using the House-Brackmann score.
Steroids and antivirus:
Steroids have been shown to be effective at improving recovery in Bell's palsy while antivirals have not. Antivirals are ineffective in improving recovery from Bell's palsy beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell's palsy and the herpes simplex and varicella zoster virus. There is still the possibility that they might result in a benefit less than 7% as this has not been ruled out.
Surgery may be able to improve outcomes in facial nerve palsy that has not recovered. The efficacy of alternative medicines remains unknown because the available studies are of low quality.
Call for 24/7 free Consultation
Dr.Nakkiran.PT. Physical Therapist (+91 9884584525)
B.P.T., M.Sc., M.I.A.P., P.G.D.I.P.L., CPC(US)India
Unique Care Physiotherapy Centre
Home Page: http://uniquecarephysiotherapy.npage.de/HomePage.html
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