Clinical Manifestations of Bell's Palsy

Clinical Manifestations of Bell's Palsy
Clinical Manifestations of Bell's Palsy
      Usually occurs suddenly, the patient is aware of the paralysis on one side of his face when they wake up in the morning, looked in the mirror or when brush teeth / rinse or told by another person / family that one corner of his face, lower. Bell's palsy is almost always unilateral. Clinical manifestations may include loss of all voluntary movement in paralysis.
On the affected side of the face, the expression will disappear so nasolabialis crease will disappear, corners of the mouth, looking down, when drinking or gargling water dripping from the corners of the mouth, the eyelids can not be screwed so that the palpebral fissure widening and forehead wrinkles disappear.

      If the patient is asked to close his eyes the eyelid on the paralyzed side will remain open, in which paralysis N.VII, that innervate m.orbicularis oculi, can cause lagoophtalmus, ie palpebral can not close completely. Disorder will result conjungtiva and corneal trauma as eyes remain open so that the conjunctiva and the cornea becomes dry and infection. This infection can be in the form of conjunctivitis or a keratitis. As well as the patient's eyeball spin up. This situation is known as the sign of the Bell (lagophtalmus accompanied by eyeball dorsorotation). Because the eye blink is reduced, there will be irritated by dust and wind, causing epiphora. In developing cheek shows that the paralyzed side is not inflated. In addition, the food tends to accumulate between the cheek and gum side paralyzed. In addition to all the muscles of facial paralysis ipsilateral, not found accompanying other disorders, if the paralysis is strictly Bell's palsy.

•    When chorda tympani also affected, then an interruption of taste 2/3 front of the tongue which is the special sensory N.intermedius. and when the nerves leading to the m.stapedius also involved, there will be hyperacusis. This condition can be checked by audiometric examination. In more severe cases will occur in the form of tear production disorder, reduction or loss of tear production. It shows the geniculate ganglion affected and can be checked by examination Schirmer test.

• Complications to the eye, among others:
- Lagophtalmus
- Ektropion of paralytic lower eyelid
- Blush Fall
- Upper eyelid retraction
- Erosion of Cornea
- Crocodile-tears tearing

• Complications to the ear include:
Nearly half of patients with Bell palsy complained of pain in the back of the ear. Pain usually occurs simultaneously with the onset of symptoms of Bell Palsy, but in 25% of cases of ear pain occurs first 2-3 days before the onset of Bell Palsy. Some patients also complain of hyperacusis in the ipsilateral ear from occurring Palsy, which is a secondary effect of the stapedius muscle weakness.

• Taste Disorders:

Bell Palsy third of patients reported taste disturbance, of which 80% of patients with Bell palsy decreased ability to feel.

• facial spasm
Facial spasm is a rare complication of Bell Palsy, caused tonic contraction on one side of the face. Spasms usually occur at times of stress and kompreksi arising from VII nerve roots caused by vascular disorders, tumors, or nerve root demyelination process. Spasm is more often attack at the age of 50 or 60s. It can also arise Synkinesis is an abnormal contraction of facial muscles when smiling or turn a blind eye, an example of which can occur are interested in the patient's mouth when smiling or when a wink.

• Complaints and symptoms depend on the location of the lesion as follows:
a. Lesions of the facial nerve around the stylomastoid foramen either still located on the inside and outside of the foramen. Mouth down and twisted to the side so that the corners of the mouth healthy the lame position seems to be higher than a healthy position, the sufferer can not whistle, wink and closed the eyes. Excessive lacrimal will occur if the eyes are not protected / can not turn a blind eye so that the eye will be more prone to irritation in the form of wind, dust and so on, but it also lacrimal overload is caused by the process of axon regeneration and flow of the salivary glands to the tear glands at mealtime
b. Lesions of the facial canal of the chorda tympani nerve.
The whole of the above symptoms are, coupled with the loss of taste sensation of the front two-thirds of the tongue decreased salivation affected.
c. Lesions were higher in the facial canal and recognize muscular stapedius
Symptoms of clinical signs as in (a) and (b) plus the presence of hyperacusis.
d. Lesions of the geniculate ganglion.
Symptoms of clinical signs as in (a), (b), and (c) plus the onset is often acute pain in the back and in the ear. Herpes Zoster in tympanium and concha may precede circumstances arise facial nerve paralysis. Ramsay Hunt syndrome is accompanied Bell's Herpes Zoster in the geniculate ganglion, herpetic lesions seen on the tympanic membrane, external canal auditorium, and the pinna.
e. Lesions in the internal auditory meatus
Symptoms - symptoms of Bell's Palsy above plus deafness, caused by affected nerve VIII.
f. Lesions on the exit of the facial nerve through Pons
Lesions in the pons, located around the nerve core abdduces, can damage the roots of the facial nerve, abducens nerve nucleus and medial longitudinal fasciculus. Lesions in these areas can lead to muscular paralysis of the lateral rectus glance or movement towards the lesion.
g. Facial muscle movement disorder that is often encountered is called involuntary movements or facial tic spasmus clonic facial. Causes and mechanisms are not yet known exactly why it is regarded as an irritating stimulus in the ganglion feniculatum. However, the movement - involuntary facial muscle movements can rise as well as a reflection of anxiety or depression. In these involuntary movements, angular face and the eyes closed lifted excessively


•    Bell's Palsy 
•    Etiology and Pathophysiology of Bell's Palsy 
•    Bell's Palsy Diagnosis 
•    Medical Treatment and Therapy of Bell's Palsy 
•    Complications and Prognosis of Bell's Palsy


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