Bells palsy project

Under supervision of
PROF.DR\ emam el negamy
PROF.DR\ Ibrahim M.Zoheiry
Under the leadership of :
Sarah talaat Mohamed
Sara abed
Salma hassan
Safeenaz Mohamed
Sarah Arafat
Reham mahdy
Sharihan magdy
Rawan hesham
Shourouk essam
Sarah el sayed badawy
El shaimaa Mohamed
Alaa Mohamed
Youmna Mohamed
Ahmed Mohamed

The nerve that is injured with Bell's Palsy is CN-VII (7th cranial
nerve).
It originates in an area of the brain stem known as the Pons.
The 7th nerve passes through the stylomastoid foramen and
enters the parotid gland.
It divides into its main branches inside the parotid gland.
These branches then further divide into 7000 smaller nerve
fibers that reach into the face, neck, salivary glands and the
outer ear.
The nerve controls the muscles of the neck, the forehead and
facial expressions, as well as perceived sound volume.
It also stimulates secretions of the lower jaw, the tear glands
and the salivary glands in the front of the mouth.

Taste sensations at the front 2/3 of the tongue and

sensations at the outer ear are transmitted by the 7th
nerve.
Bells Palsy is caused by an
inflammation within a small
bony tube called the fallopian
canal.
The canal is an extremely
narrow area.
An inflammation within it is
likely to exert pressure on the
nerve, compressing it.

Likewise, if the nerve itself becomes inflamed within this

small canal, it can encounter pressure, with the same
result of compression.
The nerve has not yet exited the skull and divided into its
several branches, resulting in impairment of ill1functions
controlled by the 7th nerve.
If only part of the face is affection the condition is not
Bell's palsy. If, for example, the mouth area is weak but the
forehead moves, Bells palsy is ruled out.
Trauma induced by tumor, surgery, etc. can occur at a
location where the nerve has already divided into its main
branches. This type of trauma may spare one or more
branches and allow some muscles to remain functional.

The image at left illustrates the parotid gland area,

where the facial nerve divides into its major branches
after exiting the skull at the stylomastoid foramen.
The major branches then continue to divide into thousands
of microscopic nerve fibers.

WHAT IS BELL'S PALSY?

Bell's palsy is a condition that causes the facial muscles to
weaken or
become paralyzed. It's caused by trauma to the 7th cranial
nerve, and is not permanent.
WHY IS IT CALLED BELL'S PALSY?
The condition is named for Sir Charles Bell, a Scottish
surgeon who studied the nerve and its innervation of the
facial muscles 200 years ago.

IS BELL'S PALSY ALWAYS ON THE SAME SIDE?

Percentage of left or right side cases is approximately
equal, and remains equal for recurrences.
IS THERE ANY DIFFERENCE BECAUSE OF GENDER OR RACE?
The incidence of Bells palsy in males and females, as well
as in the various races Is also approximately equal.
The chances of the condition being mild or severe, and the
rate of recovery is also equal.

WHAT CONDITIONS CAN INCREASE THE CHANCE OF HAVING

BELL'S PALSY?
Older people are more likely to be afflicted, but children
are not immune to it. Children tend to recover well.
Diabetics are more than 4 times more likely to develop
Bells palsy than the general population.
The last trimester of pregnancy is considered to be a time
of increased risk for Bell's palsy.
Conditions that compromise the immune system such as
HIV or sarcoidosis increase the odds of facial paralysis
occurring and recurring.

CAN BELL'S PALSY AFFECT BOTH SIDES OF THE FACE?

It is possible to have bilateral Bells palsy, but it's rare,
accounting for less than 1%of cases.
With bilateral facial palsy, it's important to rule out all
other possible diagnoses with thorough ' diagnostic tests.
CAN BELL'S PALSY AFFECT OTHER PARTS OF THE BODY?
Bells palsy should not cause any other part of the body to
become paralyzed, weak or numb.
If any other areas are affected Bell's palsy is not the cause
of the symptoms, and further testing must be done.

HOW DO THE SYMPTOMS OF BELL'S PALSY PROGRESS?

Very quickly Most people either wake up to find they have
Bells palsy, or have symptoms such as a dry eye or tingling
around their lips that progress to classic Bell's palsy during
that same day. Occasionally symptoms may take a few days
to be recognizable as Bells palsy.
The degree of paralysis should peak within sever I day of
onset- never in longer than (2)weeks
(3)weeks maximum for Ramsey Hunt syndrome).
A warning sign may be neck.

EYE RELATED?
Muscle weakness or paralysis Forehead wrinkles disappear
Overall droopy appearance Impossible or difficult to blink
Nose runs
Nose is constantly stuffed

Difficulty speaking
Difficulty eating and drinking Sensitivity to sound
(hyperacusis) Excess or reduced salivation
Facial swelling
Diminished or distorted taste Pain in or near the ear Drooling
Eye closure difficult or impossible
Lack of tears Excessive tearing Brow droop
Tears fail to coat cornea Lower eyelid droop Sensitivity to light
ADDITIONAL SYMPTOMS WITH RAMSEY HUNT SYNDROME
Hearing deficit
Severe pain
Long lasting pain
Vertigo

Symptoms of Bell's palsy

The symptoms of Bell's palsy include:
paralysis or weakness on one side of the face
numbness
pain around the ear
the eye can't fully close
the mouth droops
the face feels heavy
foods taste slightly different

Risk factors
Bell's palsy occurs more often in people who:
Are pregnant, especially during the third trimester, or
who are in the first week after giving birth.
Have an upper respiratory infection, such as the flu or a
cold
Have diabetes.
Also, some people who have recurrent attacks of Bell's
palsy, which are rare, have a family history of recurrent
attacks. In those cases, there may be a genetic
predisposition to Bell's palsy.

Complications
- Irreversible damage to your facial nerve
- Partial or complete blindness of the eye that won't
close due to excessive dryness and scratching of the
cornea, the clear protective covering of the eye
Diagnosis:
Other conditions such as a stroke, infections, Lyme disease
and tumors - can also amuse facial muscle weakness,
mimicking Bell's palsy.
If it's not clear why you're having the symptoms you are,
your doctor may ream.
mend other tests, including.

 Electromyography (EMG).

This test can confirm the presence of nerve damage and

determine its severity.
An EMG measures the electrical activity of a muscle in
response to stimulation and the nature and speed of the
conduction of electrical impulses along a nerve.

Surgery
In the past, decompression surgery was used to relieve the
pressure on the facial nerve by opening the bony passage
that the nerve passes through.
Today, decompression surgery isn't recommended.
Facial nerve injury and permanent hearing loss are
possible risks associated with this surgery.
In rare cases, plastic surgery may be needed to correct
lasting facial nerve problems.