Bell's Palsy
Definition
Facial nerve paralysis due to unilateral inflammation of the seventh cranial nerve
Causes
Unknown
Possible causes :
Vascular ischaemia
Viral (Herpes simplex, Herpes zoster)
Autoimmune diseases
Or a combination of all of these factors
Incidence
30 cases per 100,000
Increases with age
Pregnant mother in the third trimester
Clinical Features
Weakness or paralysis of facial muscles on the affected side
Distortion of the face
Increased lacrimation (tearing)
Painful sensations in the face, behind the ear, and in the eye.
Speech difficulties
Inabilit to eat on the affected side because of weakness
Management
The objectives of treatment are to maintain the muscle tone of the face and to prevent or minimize denervation.
Reassured that no stroke has occurred and that spontaneous recovery occurs within 3 to 5 weeks.
Early Corticosteroid therapy (prednisone) to reduce inflammation and edema; this reduces vascular compression and permits restoration of blood circulation to the nerve.
Facial pain is controlled with analgesics
Heat may be applied to the involved side of the face to promote comfort and blood flow through the muscles.
Electrical stimulation to prevent muscle atrophy.
surgical decompression of the facial nerve and surgical treatment of a paralyzed face.
Promoting Home and Community-Based Care
Teaching Patients Self-Care. While the paralysis lasts, the involved (very rare)
Eye must be protected.
Frequently, the eye does not close completely and the blink reflex is diminished, so the eye is vulnerable to dust and foreign particles. Corneal irritation and ulceration
Eye should be covered with a protective shield at night. Avoid the eye patch may abrade the cornea
The application of eye ointment at bedtime causes the eyelids to adhere to one another and remain closed during sleep.
The patient can be taught to close the paralyzed eyelid manually before going to sleep.
Wrap-around sunglasses or goggles may be worn to decrease normal evaporation from the eye.
Continuing Care
When the sensitivity of the nerve to touch decreases and the patient can tolerate touching the face, the nurse can suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.
Facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling performed with the aid of a mirror in an effort to prevent muscle atrophy.
Exposure of the face to cold and drafts is avoided.
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