Facial Palsy: Facts, Causes, Infections and Management

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Facial palsy, otherwise known as Bell’s Palsy, is a condition that affects nerve and muscle in the face, causing paralysis or hanging from one side of the face. Most people who experience the situation are worried about the unbalanced imbalance they give to their face, but fortunately, this imbalance usually fails.

Bell’s palsy accounts for about 60 percent of all cases of sudden attack paralysis. Also, it affects 20 to 40 per 100,000 people a year.

CAUSES

Tumor:

A tumour that compresses the facial nerve can cause facial palsy, but usually, the facial nebula is damaged during surgical removal of a tumour. The most common neoplasm that occurs during surgical removal in facial paralysis is the Acoustic Neuromics (AKA Vestibular Schwannoma). Less commonly, cholesteatoma, hemangioma, facial schwannoma or parotid gland tumours (or the operation to remove them) are the cause.

Infections

Ramsay Hunt Syndrome:

Caused by Herpes Zoster infection = a syndrome of facial palsy, herpetiform vesicular eruptions and vestibulocochlear dysfunction. Patients who suffer from Ramsay Hunt syndrome have a greater risk of hearing loss than patients with belly paralysis, and the course of the disease is more painful. Also, there is the observation of a lower recovery rate in these patients.

Lyme disease:

Infection with Borrelia burgdorferi via tick bit is another cause of facial paralysis. Of Lyme’s disease sufferers, 10% facial palsy develops, with 25% of these patients developing bilateral facial paralysis.

Rare causes

These include:

Neurosarcoidosis, ototis media, Multiple Sclerosis, Moebius syndrome, Melkersson-Rosenthal syndrome, Guillain-Barre syndrome, Millard-Gubler syndrome AKA Ventral Pontine syndrome (Ipsilateral facial paralysis with contralateral hemiplegia caused by involvement of the corticospinal canal together with paralysis of lateral rectus on the ipsilateral side due to the participation of the abduction nerve). Foville Syndrome AKA Inferior Medial Pontine Syndrome (ipsilateral facial paralysis, contralateral hemiplegia with ipsilateral conjugate cancers). Achthalfhalf syndrome (Facial paralysis with intravenous ophthalmoplegia and horizontal cancers)

Trauma, especially temporal bone fractures

CLINICAL PRESENTATION

The paralysis of the muscles delivered by the Facial Nerve indicates the affected face of the face as follows:

Appearance and range of motion:

Impossible to close the eye

Inability to move the lips, e.g. in smile, pucker

At rest, the affected side of the face can “drop.”

The lower eyelid may fall and change outside – ‘ectropion.’

Functional effects:

Difficulty in eating and drinking as lack of lip seal makes it difficult to keep fluids and food in the oral cavity

Less clarity of speech like the “labial consonants” (i.e., b, p, m, v, f) all need lip sealing

Dryness of the affected eye – see the Dry Eye page for more details

Somatic effects:

The facial nerve delivers the lacrimal glands of the eye, the salivary glands and the stiffening muscle in the middle ear (the piles). It also sends the taste of the front 2/3 of the tongue.

Facial palsy often involves:

Lack of tear production in the affected eye, causing a dry eye, with a risk of corneal ulcers.

In the case of facial nerve paralysis two problems contribute to the drying of the eyes:

  1. The more significant petrosal nerve, derived from the facial nerve, delivers the parasympathetic autonomic component of the lacrimal gland. – Control of the production of moisture / cracking in the eyes.
  2. The zygomatic branch of the Facial Nerve delivers Orbicularis Oculi, and the resulting paralysis causes the inability (or reduced ability) to close or flash the eye so that the tears (or even artificial lubrication in the form of drops, gel or ointment) are not well spread over the cornea.

Hyperacusis:

sensitivity to sudden loud noises

Changed taste sensation

PHYSIOTHERAPY MANAGEMENT

Neuromuscular Retraction (NMR):

Provides subtle, but critically essential exercises to teach and train your brains to coordinate the facial muscles better and more efficiently.

Manual Massage:

During your session, some different massage techniques are developed to address your individual needs. The goal is to reduce muscle strength and improve flexibility and range of motion. Initially, these methods can be performed by a physical therapist, but eventually, the therapist will teach you the techniques, so you can perform them regularly at home for the greatest benefit.

Electromyography (EMG) biofeedback

Transcutaneous Electrical  Nerve Stimulation (TENS)

Proprioceptive Neuro Muscular Facilitation Techniques

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