ARIES MUHARRAM

ALWIN KASIM
 1. INTRODUCTION

□ Bell’s palsy is a form of facial paralysis resulting

from damage to the 7th (facial) cranial nerve
□ Idiopathy, suddent attack, self limiting.
□ Suspected causes; bacteria or/with viral
infection,nerve spasm, swelling/ischemic nerve,
trauma injury.
□ Any age, pregnant, diabetics, influenza, and upper
respiratory disease.
 1. INTRODUCTION

□ Bell's palsy is an acquired weakness of one side

of the face
□ Features; pain, tearing, drooling, hyperacusis &
taste diminished.
□ Reccurence is rare, except in Melkersson-
Rosenthal syndrome.
2. ANATOMY NERVE VII
INTRA ORAL
INERVATION
 3. ETIOLOGY

□ Acute otitis media

□ Atmospheric pressure change (diving, flying)
□ Expose to cold
□ Ischemia of near stylomastoid foramen
□ Local and systemic infection
□ Merkersson-Rosenthal syndrome
□ Multiple sclerosis
□ Pregnancy (third semester)
 4. FREQUENCY

□ Affect 24 every 100.00 person/year

□ Higher in winter
□ Rare under 13 year old
□ Equal in sex (higher female under 20)
□ 1:5 demyelinating disease & Multiple
sclerosis
 5. HISTOPATHOLOGIC FEATURES

□ Mild injury causes "neuropraxia". The nerve is still there, it

just is slowed down. There is decreased impulse
conduction, and prognosis is good.
□ Moderate injury -- may cause interuption of axoplasmic
flow and axonotmesis. Wallerian degeneration occurs over
2-3 weeks. Full recovery generally occurs within 2 months.
□ Severe injury is called "neurotmesis". Wallerian
degeneration occurs over 3-5 days, misdirected axon
regeneration occurs and patients experience prolonged
recovery and end up with synkinesis.
 5. HISTOPATHOLOGIC FEATURES

□ Fragmentation, swelling and degeneration is often

seen in axon cylinders.
□ There may be lymphocytic infiltration of nerve
bundles.
□ Viruses may be found -- HSV, Epstein Barr, mumps,
CMV and influenza
6. CLINICAL FEATURES
 6. Criteria for Bell’s palsy

□ (1) Paralysis or paresis of all muscle groups of one

side of the face,
□ (2) Sudden onset,
□ (3) Absence of signs of central nervous system (CNS)
disease,
□ (4) Absence of signs of ear or cerebellopontine angle
disease
 7. Classification
(House-Brackmann)
□ Grade I, Normal,
□ Grade II, Mild dysfunction,
□ Grade III, Moderate
□ Grade IV, Moderately severe disfungtion,
□ Grade V, Severe disfungtion,
□ Grade VI, Total paralisis,
 8. Examination

□ Hearing Test
□ Balance Test
□ Tear Test
□ Imaging: CT (computerized tomography)
or MRI (magnetic resonance imaging)
□ Electrical Test
 9. DIFFERENTIALS

□ Lyme disease
□ Melkersson-Rosenthal syndrome
□ Sarcadosis
□ Ramsay-Hunt syndrome
 10. MANAGEMENT

□ Prednisone (to speed recovery) must be given

within the first (60 mg/day) is given per day in a
single morning dose (7 days). and then tapered off
to nothing (10 days)
□ Antibiotics (Infection bacterial)
□ Antiviral treatment for viral infection may improve
prognosis
■ Acyclovir 400 mg 5 times daily for 10 days. or
■ Famciclovir 500 mg tid.
 10. MANAGEMENT

□ Surgery is not needed in most cases of idiopathic

Bell's palsy,
■ 90% of patients recover spontaneously.
■ Trauma, facial nerve decompression may be
justified.
■ Controversial

□ Several surgical procedures are available to improve

cosmetic appearance.
 10. MANAGEMENT

□ The Botox injected in the muscles

around the eye reduce spasms
□ Physical therapy with severe
residual impairments at least 1 year
after onset,
 11. Complication

□ 75% good healing at 2-3 week

□ 15% recurent
□ 5-10% bad result therapy
□ 7% recurent in 4 month,
 12. PROGNOSIS

□ Good (82% recovery in 6 month)

 12. CONCLUSION
• Bells palsy was idiopathy paralysis facial
nerve.
• Attack any one,
• Higher rate in winter
• Good diagnose and management lead to
maximal normal fungtioning
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