Anatomy of Head, Neck and Trunk 

Introduction to Bell’s Palsy

Bell’s palsy is a clinical condition that can bring about a temporary weakness or paralysis of the muscles of the face. This is mainly brought about due to inflammation, compression or injury to the seventh cranial nerve known as the facial nerve. The damage caused is usually temporary and in some of the severe cases the damage can be irreversible as well. Generally a unilateral paralysis is observed in the patient’s affected by the same.

Pathology

It is mainly brought about by the compression of the seventh cranial nerve at the site of geniculate ganglion. The first portion of the facial nerve known as the labyrinthine segment is the narrowest of all and it is the most common place for compression to occur. Due to this narrow opening the inflammation in the nerve can bring about compression and ischemia of the nerve. This then brings about a generalized weakness to the facial muscles supplied by its route (Bhargava, 2016).

Epidemiology

The annual incidence of occurrence of Bell’s palsy is 15 to 20 people being affected out of every 100000 people. Only one of the case can be observed to be subjected to any risk factors. Even without any treatment intervention almost 70 % of the people have been seen to get a complete resolution. There is not gender or race specificity in terms of occurrence of this condition. It can also develop at any age, ranging from mid years to late life as well (Mustafa, 2018).

Clinical presentation of Bell’s Palsy

The symptoms of Bell’s palsy usually develop one or two weeks after there is an ear or eye infection. The symptoms might appear abruptly and the patients generally feel a pain or discomfort while trying to eat or drink. Some of the salient clinical presentation of the condition include the following:

  • Difficulty in eating or drinking.
  • Drooling of saliva.
  • Inability to perform facial expressions such as smiling or frowning.
  • Generalized facial weakness especially in the morning or at night.
  • Muscle twitching is also observed in the face.
  • Dryness of eyes and mouth.
  • Constant dull aching headache.
  • Sensitivity to high pitched or high volume sounds.
  • Some of the patients might also observe tooth discomfort.
  • Drooping appearance on the affected side of the face with an inability to open or completely close the eyes (Henkel, 2017).

Effect of Pathology on Anatomy

The main nerve involved in Bell’s palsy is facial nerve or the seventh cranial nerve. The nerve is involved in providing efferent motor innervation to the muscles of face, the stapedius and posterior digastric muscles. The parasympathetic branches of the nerve supplies the lacrimal glands and submandibular glands as well. All of these fibers are therefore, susceptible to paralysis if the facial nerve gets involved. The facial nerve also enters the temporal bone through the internal acoustic meatus. It continues down via the fallopian tube and exists through the stylomastoid foramen. The lateral end of the internal auditory canal is the narrowest part of the fallopian tube (Jain, 2018). The inflammation caused in the facial nerve, mainly causes this narrow part to narrow down much further. Due to this the passage tends to get blocked temporarily and thus, causes a temporary loss of the sensory and motor function of the nerve. If the infection prolongs the inflammation also tends to prolong, leading to a permanent nerve degeneration in later stages.

Intervention for Bell’s Palsy

The treatment interventions can be broadly classified into following categories:

  • Medical management- The main choice of drugs are corticosteroids as it will help in reducing inflammation. Pain medication are also a drug choice for helping reducing associated pain. Some of the common pain drugs include ibuprofen (Portela, 2019). If the infection is caused due to an underlying bacterial or viral infection the treatment medication chosen for the treatment can also be inclusive of antiviral or antibacterial drug. Eye drops are also given to manage the eye infection as well as to maintain the moisture of the eye.
  • Physical therapy intervention are the most helpful in this case as these interventions given in the early stages of detection can help in resolving the symptoms within short time span. The most common intervention used is stimulation with the help of muscle stimulator. The nerve course if stimulated to motor points to bring about nerve re-education. The facial region affected is also given facial massage to enhance the blood flow in the region and thus, help in nutrient flow to the site. This is also beneficial to reduce the swelling on the face. The patient can also be taught facial exercises such as spelling vowels (Alptekin, 2017). The patient is also asked to sit in front of the mirror and make facial expression so that they get a biofeedback of the facial deficit and work on it accordingly. The facial stretch is also given by the physical therapist on the affected side to ensure to make the elasticity of the face sustain. A warm moist towel can also be placed on the face to ensure pain relief post treatment management.

Prognosis

Out of all of the cases almost 70 % of the cases that are left untreated, tend to resolve on their own. Treatment done with the help of corticosteroids has found to be more effective and also helps in fastening the recovery process. There is also almost a 10 % rate of reoccurrence of the symptoms in the later 10 years of life. A rate of recurrence has been reported between the ranges of 5-15% in mid years of life of an individual.

Conclusion on Bell’s Palsy

Bell’s palsy is not a rare condition and is not also fatal in most of the incidences. The early signs and symptoms should be checked with the doctor. Use of protective gears while swimming is necessary in order to prevent the chances of development of ear infection. The ear and eyes cavity should be cleaned and kept out of infections for reducing the chances of catching infection. The recovery rate is also substantial, even in cases where no intervention is being given to the patient.

References for Bell’s Palsy

Alptekin DÖ. Acupuncture and Kinesio Taping for the acute management of Bell’s palsy: A case report. Complementary therapies in medicine. 2017 1;35:1-5.

Bhargava P, Toshniwal OD, Sharma R, Das M, Mohapatra S, Verma A. Bell's Palsy: A Systematic Review of Two Cases. Indian Journal of Contemporary Dentistry. 2016;4(1):84-7.

Henkel K, Lange P, Eiffert H, Nau R, Spreer A. Infections in the differential diagnosis of Bell’s palsy: a plea for performing CSF analysis. Infection. 2017 1;45(2):147-55.

Jain S, Kumar S. Bell's Palsy: A Need for Paradigm Shift?. Annals of Otology and Neurotology. 2018 ;1(01):034-9.

Mustafa AH, Sulaiman AM. The Epidemiology and Management of Bell’s Palsy in the Sudan. The Open Dentistry Journal. 2018;12:827.

Portela RC, Miller AC. Antivirals With Corticosteroids for the Treatment of Acute Bell's Palsy. Acad Emerg Med. 2019 1;26(3):342-4.

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