Dr ALM RIAS MD

1. Laqva (Bell Palsy)
SUBMITTED BY:
Dr.ALM Rifas
MD Scholar ( 2nd Year )
Internal Medicine (Moalajat)
SUMER
Jamia Hamdard
SUBMITTED TO:
Prof. Yasmeen Shamsi
Dept. of Moalejat
SUMER, Jamia Hamdard

2. General Characteristics
• Bell's palsy is a type of facial paralysis that results in an inability
to control the facial Muscle on the affected side. Symptoms can
vary from mild to severe. They may include muscle twitching,
weakness, or total loss of the ability to move one, and in rare
cases, both sides of the face.
• This refers to hemifacial weakness/paralysis of muscles
innervated by CN VII due to swelling of the cranial nerve.
• The prognosis is very good; 80% of patients recover fully within
weeks to months.

4. Causes
Virus:
• The herpes virus is common cause of inflammation of the facial nerve.
• The herpes simplex virus (HSV), including either herpes type 1 (HSV-1) which
causes cold sores or herpes type 2 (HSV-2) which causes genital herpes.
• The varicella-zoster virus, which causes chickenpox and shingles.
Facial Nerve:
• The facial nerve (VII) passes through a narrow gap of bone near the upper jaw
on its way from the brain to the face. If the facial nerve is compressed or swollen
it can interfere with the signals that brain sends to the muscles of the face.
• This interference can restrict the blood and oxygen supply to nerve cells and
cause the facial weakness or paralysis that is characteristic of Bell's palsy.

5. Clinical Features
•Irritation of the affected eye, such as dryness or increased tear production
•Pain underneath the ear on the affected side of the face
•Drooling from the mouth on the affected side of the face
•Dryness of the mouth
•Difficulty in eating or drinking
•Impaired speech
•Weakness or paralysis in one side of the face, which may make it difficult to close the
eyelid and cause the side of the mouth to droop
•An altered or reduced sense of taste
•Increased sensitivity to sound in the affected ear
•Pain around the jaw
•Headache
•Dizziness

7. Diagnosis
• Diagnosis is clinical, but consider Lyme disease in endemic
areas as the treatment approach is different.
• Consider EMG testing if paresis fails to resolve within 10
days.
• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) scan

8. Differential Diagnosis for Facial Nerve Palsy
• Trauma (e.g., temporal bone, forceps delivery)
• Lyme disease
• Tumor (acoustic neuroma,cholesteatoma,neurofibroma)
• Guillain–Barré syndrome (palsy is usually bilateral)
• Herpes zoster

9. Treatment
• 1. Usually none is required, as most cases resolve in 1 month.
• 2. Short course of steroid therapy (prednisone) and acyclovir,
if necessary.
• 3. Patient should wear eye patch at night to prevent corneal
abrasion (cornea is exposed due to weakness of orbicularis
oculi muscle).
• 4. Surgical decompression of CN VII is indicated if the
paralysis progresses or if tests indicate deterioration.

10. Management
Pain relievers: Paracetamol and NSAIDs (non-steroidal anti inflammatory drugs) such as
ibuprofen etc. are effective pain killers.
Hot and cold treatment: Hot bath or a hot water bottle placed on the affected area
helps ease the pain. Cold treatment such as an ice pack or a bag of frozen vegetables,
placed on the painful area is also effective.
Relaxing: Trying to relax is a crucial part of easing the pain because muscle tension
caused by worrying about condition can make things worse.
Medication: Corticosteroids like Prednisolone helps in reducing inflammation (swelling),
which should also help to speed up your recovery.
Regimental therapy : Hijama , facial massage etc.

11. Thankyou