A. Take Rest especially in the acute phase
The first therapy that is just enough rest during the attack or acute period. This is to rest the nerve and muscle paralysis.
a. Corticosteroids (prednisone at a dose of 40 -60 mg / day orally or 1 mg / kg / day for 3 days, reduced slowly over 7 days later), in which the administration began on the fifth day after the onset of disease, point to improve the chances of recovery patients.
The basis of this treatment is to reduce the possibility of permanent paralysis caused by swelling of the facial nerve, in a narrow facial canal.
b. antiviral medicines. Acyclovir (400 mg for 10 days) may be used in the treatment of Bell's palsy in combination with prednisone or can also be given as a single dose for patients who can not consume prednison. Acyclovir is useful if given in the first 3 days of the onset of the disease to prevent viral replication .
c. Eye Care:
• Artificial tears: use during conscious to replace the missing lacrimation.
• Lubricants used during sleep: Can be used during conscious if artificial tears can not afford adequate protection menyedikan. One disadvantage is blurred vision.
• Protective glasses or shield the eyes from trauma and decrease drying by reducing exposure to direct air to the cornea
Often worked together giving prednisone, may be recommended in the acute stage. The purpose of physiotherapy to maintain paralyzed muscle tone. Ways that are often used are: massage / facial muscle massage for 5 minutes in the morning-afternoon or faradisation.
Measures Surgery is generally not recommended in children because it can cause local and intracranial complications.
Surgery performed the action if:
• there is no spontaneous healing
• there is no improvement with prednisone treatment
- Tear production is reduced to <25%
- The flow of saliva is reduced to <25%
- The response to electrical tests between the healthy and the sick distinct 2.5 mA.
Several surgical therapies that can be done such as facial nerve decompression, Subocularis oculi Fat Lift (SOOF), implantation of the device to the eyelid, tarsorrhapy, muscular transposition of the temporale muscle, facial nerve grafting and direct brow lift.
American Academy of Neurology does not currently recommend surgical decompression for Bell's palsy. The most common complication of surgery is that hearing loss after Surgery.
Physicians who treat patients must follow a strict examination. Documentation should include the progress made healing the patient. Various opinions exist concerning the need for referral to a specialist. Indications to refer to is as follows:
1. Neurologist: when encountered neurological signs on physical examination and signs that are not typical of Bell palsy, then immediately referred.
2. Ophtalmologist: if there is no apparent ocular pain or picture abnormal on physical examination, the patient should be referred for further investigation.
3. Otoryngologist: in patients with persistent paralysis, muscle weakness of the old faces, or recurrent weakness, should be referenced.
4. Surgeon: surgery to relieve the facial nerve is sometimes recommended for patients with Bell palsy. Patients with a poor prognosis following a persistent paralysis of the facial nerve or good enough to do surgery.
F. Medical Rehabilitation
WHO medical rehabilitation are all measures aimed to reduce the impact of disability and handicap and to improve the ability of people with disabilities achieve social integrity.
Medical rehabilitation objectives are:
• Eliminates the disability if possible
• Reduce disability as much as possible
• Train patients with residual disability to live and work. To achieve success in rehabilitation objectives effectively and efficiently will require medical rehabilitation team consisting of doctors, physiotherapists, occupational therapists, prosthetic ortotis, speech specialists, psychologists, medical social workers and nurses medical rehabilitation.
In accordance with the concept of medical rehabilitation is a joint effort integrated in terms of medical, social and workmanship, the goal of medical rehabilitation in Bell's palsy is to reduce / prevent paresis increased and help solve social problems as well as the psychology that people can still carry out activities of daily activities. The programs are given a program of physiotherapy, occupational therapy, medical social, psychological and prosthetic orthotic, while the rehabilitation treatment programs, and speech therapy are not a lot of play.
1) Physiotherapy Program
- Superficial heating with infra red.
- Warming in the form of Shortwave Diathermy or Microwave Diathermy.
b. Electrical stimulation
The purpose of giving electrical stimulation to stimulate the muscles to prevent / slow the atrophy occurs while waiting for the regeneration and strengthen weak muscles. For example, by faradisation whose purpose is to stimulate muscle re-education of muscle action, train new muscle function, improve circulation and prevent / stretch adhesions. Given 2 weeks after onset.
c. Exercise facial muscles and facial massage
Voluntary movement of facial muscles exercises given after the acute phase. Exercise in the form of raised eyebrows hold 5 seconds, frowning, closing the eyes and lift the corners of the mouth, smile, whistle / blow (done in front of the glass with full concentration).
Massage is a systemic and scientific manipulation of body tissues for the purpose of repairs / restoration. In the acute phase, Bell's palsy given a gentle massage slowly and rhythmically. Gentle massage gives the effect of reducing edema, muscle relaxation and maintaining muscle tone. After passing the acute phase, Deep Kneading Massage given before exercise voluntary movement of facial muscles. Deep Kneading Massage mechanical effect on venous blood and lymph vessels, launched disposal of metabolic, lactic acid, reduce edema, improve nutrition muscle fibers and increase the movement of intramuscular thus releasing adhesions. Massage the face divided into 4 areas: chin, mouth, nose and forehead. All the movements are directed upward, the length of 5-10 minutes.
2) Occupational Therapy Program
Basically here provides exercise therapy movement in the facial muscles. Training is given in the form of daily activities or in the form of a game. Keep in mind that the exercise gradually and see the condition of the patient, the patient should not be exhausting. Exercise can be rinsed exercise, workout drink with a straw, blow out the candle exercise, exercise close their eyes and frowned in the mirror.
3) Medical Social Programs
Bell's palsy sufferers often feel ashamed and withdrew from social interaction. Social problems usually associated with the workplace and costs. Medical social worker can help solve by calling the workplace, may temporarily be working on a lot of parts that are not related to the general. For the cost issues, assisted with finding health facilities in the workplace or through family. Besides providing information that cooperation with workers treating patients is critical to patient recovery.
4) Psychological Program
For certain cases where there is a very prominent psychic disturbances, anxiety often accompany the patient, especially on young people, women or people who have a profession that requires he often appeared in public, then the help of a psychologist is needed.
5) Program orthotic - Prosthetics
To do the installation of the "Y" plaster corners of the mouth in order not to fall ill. It is recommended that the plaster was replaced every 8 hours. It should be noted leather intolerance reactions that often occur. Installation of "Y" plaster performed within 3 months if there has been no change in patients after undergoing physiotherapy. This is implemented to prevent Zygomaticus muscle stretsched during parese and prevent contractures.
6) Home Program:
a. Warm compresses the diseased area of the face for 20 minutes
b. Massage the sore faces upward by hand from the healthy side of the face
c. Exercise inflatable candles, rinse, eat by chewing the side of the sick, drink with a straw, chewing gum
• Bell's Palsy
• Etiology and Pathophysiology of Bell's Palsy
• Clinical Manifestations of Bell's Palsy
• Bell's Palsy Diagnosis
• Complications and Prognosis of Bell's Palsy
MEDICAL BOOKS ABOUT BELL'S PALSY
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