Bell's palsy
Bell's palsy: Excerpt from Handbook of Diseases
Bell’s palsy is a neurologic disorder that affects the seventh cranial (facial) nerve, producing unilateral facial weakness or paralysis. Onset is rapid. Although it affects all age-groups, it’s most common in persons younger than age 60. In 80% to 90% of patients, it subsides spontaneously, with complete recovery in 1 to 8 weeks; however, recovery may be delayed in older adults. If recovery is partial, contractures may develop on the paralyzed side of the face. Bell’s palsy may recur on the same or opposite side of the face.
Causes
The seventh cranial nerve is responsible for motor innervation of the facial muscles. With Bell’s palsy, the nerve is blocked by an inflammatory reaction around the nerve (usually at the internal auditory meatus). This is commonly associated with infections (most likely herpes simplex) and can result from hemorrhage, tumor, meningitis, or local trauma.
Signs and symptoms
Bell’s palsy usually produces unilateral facial weakness, occasionally with aching pain around the angle of the jaw or behind the ear. On the weak side, the mouth droops (causing the patient to drool saliva from the corner of his mouth), and taste perception is distorted over the affected anterior portion of the tongue. In addition, the forehead appears smooth, and the patient’s ability to close his eye on the weak side is markedly impaired. When he tries to close this eye, it rolls upward (Bell’s phenomenon) and shows excessive tearing. The patient also has hypersensitivities to sound.
Although Bell’s phenomenon occurs in those without Bell’s palsy, it isn’t apparent because the eye closes completely and covers this eye motion. In Bell’s palsy, incomplete eye closure makes this upward motion obvious.
Diagnosis
Patients with Bell’s palsy typically have a distorted facial appearance and inability to raise the eyebrow, close the eyelid, smile, show the teeth, or puff out the cheek. After 10 days, electromyography helps predict the level of expected recovery by distinguishing temporary conduction defects from a pathologic interruption of nerve fibers.
Treatment
With Bell’s palsy, treatment consists of prednisone, an oral corticosteroid that reduces facial nerve edema and improves nerve conduction and blood flow. In some cases, prednisone may be combined with acyclovir. After the 14th day of prednisone therapy, electrotherapy may help prevent atrophy of facial muscles.
Special considerations
❑ If the patient is being treated with prednisone, watch for adverse reactions, especially GI distress and fluid retention. If GI distress is troublesome, the patient may benefit from an antacid. If the patient has diabetes, prednisone must be used with caution and serum glucose levels must be frequently monitored.
❑ To reduce pain, apply moist heat to the affected side of the face, taking care not to burn the skin. If the patient is given an analgesic, monitor him for therapeutic effect of the drug.
❑ To help maintain muscle tone, massage the patient’s face with a gentle upward motion two to three times daily for 5 to 10 minutes, or have him massage his face himself. When he’s ready for active exercises, teach him to exercise by grimacing in front of a mirror.
❑ Advise the patient to protect his eye by covering it with an eye patch, especially when outdoors. Tell him to keep warm, to avoid exposure to dust and wind, and to cover his face when exposure is unavoidable.
CLINICAL TIP: To prevent complications related to swallowing difficulty (aspiration and weight loss), instruct the patient to always sit up straight when eating, chew on the unaffected side, take small bites, and eat nutritionally balanced meals, while avoiding foods that are hard to chew.
❑ Arrange for privacy at mealtimes to reduce embarrassment.
❑ Apply a facial sling to improve lip alignment.
❑ Give the patient frequent and complete mouth care, being careful to remove residual food that collects between the cheeks and gums.
❑ Offer psychological support. Give reassurance that recovery is likely within 1 to 8 weeks.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Bell's Palsy
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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» Next page: Drooling (Nursing: Interpreting Signs and Symptoms)
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