Bells Palsy (CN VII)

Question 1

Bells Palsy Incidence

Answer 1

• Facial nerve is unilaterally affected (CN VII)
• Most common between ages 15-45 years old

Question 2

Bells Palsy Etiology

Answer 2

• Cause is uncertain
• Primary cause is indicated to be latent herpes virus that has been reactivated
• Days before onset, patient may experience severe pain in mastoid or sensation of fullness in ear
• Compression initially causes demyelination and ischemia will cause axonal degeneration
• Tumor can produce unilateral paralysis in face by impinging facial nerve as it emerges from brainstem but this teds to produce a slowly progressive paralysis

Question 3

Bells Palsy Risk Factors

Answer 3

• DM
• Pregnancy

Question 4

Bells Palsy Clinical Manifestations

Answer 4

• Unilateral facial paralysis develops overnight
• Corner of mouth droops
• Eyelid does not close
• Can have loss of taste on affected side
• May experience dry eye (lack of tearing) and will produce less but thicker saliva

Question 5

Bells Palsy Diagnosis

Answer 5

• Wrinkle forehead
• Closes eyes tightly
• Whistle to observe facial asymmetry
• With LMN involvement, client is unable to close eye wrinkle forehead, or smile voluntary
• With UMN involvement, client can close eye and wrinkle forehead but cannot smile voluntarily

Question 6

Bells Palsy Treatment

Answer 6

• Corticosteroids for five days followed by tapered dose for five days
• Treatment should begin as soon as possible and no later than 10 days after onset of signs of paralysis
• Treatment with antiviral meds (due to underlying herpes zoster) — Acyclovir
• Treated within 3 days, 100% recovery
• Recovery drops to 86% when treatment delayed to day 4
• Client should cover eye with patch or glasses and use artificial tears to protect cornea
• Other palliative treatments, such as gentle massage and gentle heat, may also be used

Question 7

Bells Palsy Prognosis

Answer 7

• Recovery within 3 weeks for individuals with incomplete involvement
• For complete involvement, 75% recover normal motor function but recovery is longer
• Poorer outcome if over 60 years old or in the presence of comorbidities
• Plastic surgery can help restore facial function when recovery does not occur

Question 8

Bells Palsy PT Implications

Answer 8

-Twice daily exercise program emphasizing facial movement
- Progress can be assessed using facial grading scale, paresis index, and question score
- Electrical stimulation should not be used