Bell’s Palsy Flashcards
What is Bell’s Palsy?
A neurological condition involving a lesion of the facial nerve (CNVII) that causes weakness or paralysis of the muscles on the same side of the face.
One of the most common neurological conditions
Facial nerve leaves the brain stem and then separates into two divisions: one motor division and one mixed sensory and autonomic division
Motor division supplies function to muscles of facial expression: temporal, zygomatic, buccal, mandibular and cervical branches
Sensory and autonomic division enables taste in anterior two thirds of tongue, and controls submandibular and sublingual salivary glands, lacrimal glands and small sensory area of soft palate and around external auditory meatus
Causes
Compression from edema (pregnancy, middle ear infection, diabetes, hypertension, hypothyroidism, leprosy or tumor)
Conditions affecting parotid gland (mumps or cancer)
Compression from inflammation secondary to trauma (blow or stab wound, forceps used during birth)
Exposure to chill or draft
Symptom Picture
Rapid onset of unilateral weakness ranging from mild to severe
Flaccid paralysis of muscles of facial expression
Headaches are common
May be unable to open or close eye
Loss of blinking reflex
Inability to flare nostrils, raise corners of mouth, whistle or pucker
Difficulty eating, articulating sounds and holding lower lip to glass to prevent dribbling
Loss of control of lacrimation and usually decreased salivation
Loss of taste to anterior two thirds of tongue
Pain not usually a primary symptom
Health History Questions
History of systemic disorder?
Diagnosed Bell’s Palsy?
Has there been a prognosis given?
When did symptoms begin?
Known cause?
Any treatment prescribed? Eye patch?
ADL’s affected?
Sensory loss or change?
Any pain? Describe
Observation
Pulling of face downward on affected side
Facial expressions distorted
Head may be positioned down and away in order to hide affected side
Tearing may be seen
Eye patch
Palpation
Palpation is light
Flaccidity palpated
Edema may be palpated
Testing
AROM of facial expressions
Close affected eye
Strength testing of orbicularis oculi muscle positive
Contraindications
Concern about eye infection if eye cannot close and tearing is diminished
Pressure during massage is modified on flaccid tissue
Long dragging strokes and fascial techniques are CI’d on affected side
Treatment
No prone position as tissue is fragile and flaccid
Care is taken while stabilizing head to work unaffected side to not add too much pressure to affected side of face.
Could use a small towel between therapist hand and client’s face
If eye patch used, keep it on to make sure nothing gets into eye and cause infection
Hydro of cool washes on affected tissues, applications of warm heat can be used
Decrease SNS firing
Massage to unaffected side first
Massage to platysma if affected
Massage to compensatory pecs, posterior neck and shoulder
Lymph drainage to decrease edema
Unaffected facial muscles are treated with pressure of strokes directed towards lesion site (affected side), lateral to midline of face: can include fingertip kneading, compressions, stroking, vibrations
Affected side is addressed in the same manner except that pressure of strokes is from midline on face laterally towards the lesion site. No fascial techniques used
Massage followed by passive movements. Therapist can raise client’s eyebrow, raise corner of lip
Gentle ROM of TMJ and c-spine
Self Care
Diaphragmatic breathing, visualization and meditation
Self massage
Passive and active assisted movements of affected muscles: use a mirror-wrinkle forehead with eyebrows, flare nostrils, sating vowels and consonants, smile with and without teeth showing
