03/09/2021
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Bell's palsy is an unexplained episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours. This condition results from damage to the facial nerve (the 7th cranial nerve). Pain and discomfort usually occur on one side of the face or head.
Bell’s palsy is a form of temporary facial paralysis or weakness in the muscles on one side of the face. It results from damage, inflammation, irritation or trauma to the facial nerves. In Bell’s palsy, one side of the face appears to droop – resulting in a crooked smile and partially closed eye. Tear and saliva production, as well as the sense of taste, may also be affected.
🔴Anatomy of the Facial Nerve
The facial nerve arises in the pons (formed as separate sensory and motor roots), before travelling in the internal acoustic meatus, very close to the inner ear. As they enter the facial canal, the two roots fuse to form a single facial nerve, before giving off intracranial branches of the greater petrosal nerve, nerve to stapedius, and chorda tympani.
The facial nerve then exits the facial canal (and the cranium) via the stylomastoid foramen. The first extracranial branches given off are the posterior auricular nerve, nerve to digastrics, and nerve stylohyoid. The facial nerve then enters the parotid gland, dividing into terminal branches of the Temporal, Zygomatic, Buccal, Marginal mandibular, and Cervical branches.
🔴Signs and Symptoms
➡️Facial droop and difficulty smiling or closing one eye
➡️Headache
➡️Increased or decreased salivation or drooling
➡️Increased sensitivity to sound on affected side
➡️Increased or decreased tear production
➡️Pain around jaw or behind ear on affected side
➡️Sudden onset of mild weakness to total paralysis of one side of the face
➡️Reduced sense of taste
🔴Causes
Bell’s palsy is usually linked to inflammation of the nerve from a viral infection, so behaviors and lifestyle factors don’t play a part in its appearance. Viruses linked to Bell’s palsy include:
➡️Adenovirus, which causes respiratory illnesses
➡️Coxsackievirus, which causes hand-foot-and-mouth disease
➡️Cytomegalovirus
➡️Epstein-Barr, which causes mononucleosis
➡️Herpes simplex, which causes cold sores and ge***al herpes
➡️Herpes zoster, which causes chickenpox and shingles
➡️Influenza B
➡️Mumps virus
➡️Rubella, or German measles
➡️Lyme disease, an infection from the bite of a deer tick, can also present as a Bell’s palsy and may involve both sides of the face rather than just one.
🔴Assessment
There's no specific test for Bell's palsy. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
🔴Mechanism of Injury / Pathological Process
The facial nerve is damaged by inflammation within the nerve causing it to become enlarged, at the point where the nerve exits the skull through the stylomastoid foramen.
Ischemia occurs as the nerve swells in its bony canal, blocking neural blood supply.
Having said that Bell's Palsy is a diagnosis of exclusion and that we are not certain what causes the nerve inflammation, there is some evidence to suggest that in the majority of cases it is likely to be linked to Herpes Simplex infection
🔴Exercises
🔑Facial Stimulation
Before you begin the facial exercises, it’s important to warm up and stimulate your muscles first.To correctly do these facial exercises, experts suggest sitting in front of a mirror so that you can clearly see your face and watch your muscle movements.
Step 1: Begin by trying to move every part of your face slowly and gently.
Step 2: Use your fingers to gently lift your eyebrows. One side will lift higher than the other, but don’t apply too much force to the side that is drooping.
Step 3: Using your fingers, gently massage the different parts of your face, including your forehead, nose, cheeks, and mouth.
🔑Nose and Cheek Exercises
After warming up, you can work on the area of your cheeks and nose. This area is important since any stiffness or weak muscles in this zone can affect the strength of the entire face as you recover.
Step 1: Using your fingers, gently push up the skin next to your nose on the affected side while trying to wrinkle your nose.
Step 2: Try to scrunch up your face, focusing on the cheeks and nose.
Step 3: Flare your nostrils and try to take some deep breaths through your nose. You can cover your unaffected nostril to force the affected muscles to work harder.
Step 4: Puff up your cheeks and blow the air out. Repeat this 10 times.
🔑Mouth Exercises
The next area that you can work on is your mouth, including your lips and tongue. Many people with Bell’s palsy find it difficult to eat and drink since muscle movements are limited. Some also find that they dribble or aren’t able to control their saliva, which can be stressful.These exercises for Bell’s palsy can help you to regain better control of your mouth. You can repeat them 30 times each, up to 4 times a day.
Step 1: Open your mouth as if you are going to smile and then close it. Then do the opposite and practice frowning.
Step 2: Gently pucker your lips and let them relax.
Step 3: Try lifting each corner of your mouth individually, one at a time. You can use your fingers to help lift up the affected side.
Step 4: Stick out your tongue and then aim it down toward your chin
🔑Eye Exercises
People with Bell’s palsy may have difficulty closing their affected eye, which can be bothersome and makes it difficult to sleep. These facial exercises help you to regain control and function of the muscles surrounding the eyes.
Step 1: Practice raising your eyebrows up and down. You can use your fingers to lift the affected eyebrow.
Step 2: Look down and close your eye while gently massaging the eyelid and eyebrow.
Step 3: Alternate opening your eyes wide and then gently squeezing them shut
⚠️you shouldn’t overexert yourself or your muscles. Don’t worry about completing all of the exercises if your muscles are telling you to stop.
Also, you don’t want to force the two sides of your face to work against each other. If during your exercises for Bell’s palsy you see that muscles are moving or pulling, you should stop. Relax your muscles and take a rest.
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