Physical Medicine And Rahabilitation

Facial Palsy & Trigeminal Nerve

Murat KOÇIV.Year V. Course

What is Facial Palsy?

This is paralysis of part of the face caused by non-functioning of the nerve that controls the muscles of the face, especially the muscles around the eye and to the mouth. This nerve is called the Facial Nerve.

What is the Facial Nerve?

The nerve affected in facial palsy, the facial nerve, is one of the cranial nerves.  It has a complex course from the brain stem to reach the muscles of facial expression. It supplies and controls the muscles that lift the eyebrows high, the muscles that close the eyelids, the muscles of the cheek and around the mouth.

Facial palsy can be acquired causes of facial palsy include most commonly Bell's palsy. This can have no cause or be secondary to infection, or can be because of lack of the blood supply to the nerve. Sometimes a tumor, such as an acoustic neuroma, or parotid gland, or temporal bone tumor can compress the nerve and damage it. Birth trauma or skull fracture can also cause a facial palsy.

Causes...

Bell's palsy

Bell's Palsy

Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve 7 (the facial nerve) that results in the inability to control facial muscles on the affected side. Several conditions can cause facial paralysis.

Bell's palsy is the most common acute mononeuropathy and is the most common cause of acute facial nerve paralysis.

Bell's palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The hallmark of this condition is a rapid onset of partial or complete palsy that often occurs overnight.

It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell's palsy has been found.

Change in facial expression

Difficulty with eating and drinking

Drooling due to lack of control over muscles of the face

Droopy eyelid or corner of mouth

Dry eye or mouth

Face feels stiff or pulled to one side

Facial paralysis of one side of the face, makes it hard to close one eye

Headache & Loss of sense of taste

Pain behind or in front of the ear

Sensitivity to sound (hyperacusis) on the affected side of the face

Twitching in face-Weakness in face

Signs and Symptoms

Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g., the varicella-zoster virus and Epstein-Barr viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell's palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress - emotional stress, environmental stress (e.g., cold), physical stress (e.g., trauma) - in short, a host of different conditions, may trigger reactivation.

Cause of Bell's palsy...

Blood tests for sarcoidosis or Lyme diseaseMagnetic resonance imaging (MRI)Electromyography (EMG) Nerve

conduction test

Tests and Diagnosis...

It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell's palsy...  

In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy. In a few cases, bilateral facial palsy has been associated with acute HIV infection.

Pathology...

MassagePhysiotherapy AcupunctureAcupressureAntiviralsSteroidsSurgeryComplementary therapy

Treatment...

Bell's palsy is a condition resulting from nerve damage. Bell's palsy may cause the facial nerves to paralyze partially. People with this condition cannot really to generate any facial expressions.

Massage For Bell's Palsy...

Start massaging the lower part of your facial muscles. Use your fingers to spread your lips as if you were smiling. Now use your thumb and index finger to grasp the corner of your lips. Push the center in to create a puckering effect. Keep repeating this motion for at least 20 minutes.

Now move on to the upper part of your face. Place your index finger and your middle finger on your forehead while massaging the hairline and the upper part of your forehead with your thumb. Now try and reverse the motion so that you are massaging the skin around your eyebrows.

Use your finger tips to massage your cheeks in slow, gentle and circular motions. Use very firm strokes on your cheeks, especially on the upper part of the face. Using some strength while massaging the cheeks can help prevent the nerve damage from lasting too long. It will also prevent muscle atrophy in your face.

After you have finished massaging all the parts of your face, begin applying some moist heat to your skin. To do this, you can use a warm compress or simply soak a washcloth in warm water and create a hot pack by squeezing the excess water. Apply this all over your face after

you are done with your facial exercises.

Physiotherapy can be beneficial to some individuals with Bell’s palsy as it helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve. It is important that muscle re-education exercises and soft tissue techniques be implemented prior to recovery in order to help prevent permanent contractures of the paralyzed facial muscles.

Physiotherapy...

In Traditional Chinese Medicine the good health of an individual is dependent on

the smooth flow of energy or Qi (Chee) in and around the body. This energy flows

through the body in meridians or pathways and blockage or disruption of

the flow results in pain or disease. Acupuncture involves the insertion of very fine sterile needles into specially

selected acupuncture points,

Acupuncture...

In China, Bell’s palsy is called Zhong Feng which literally translates to “Wind Attack.” It is believed that Bell’s palsy is caused when Wind and Cold invade the meridians, muscles and tendons of the face. This frequently happens when the immune system is deficient and the body’s defenses are weak. The normal flow of Qi and Blood is disrupted in the face resulting in malnourishment of the facial muscles and tendons. In Chinese medicine symptoms of Qi and Blood deficiency include muscle weakness or paralysis, numbness and tingling; these corresponding to the symptoms produced by irritation of the 7th cranial (facial) nerve.

The goal of treatment is to expel the Wind-Cold from the meridians, improve the circulation of Qi and Blood to nourish the muscles and restore nerve and muscle function. As muscle contraction improves, the treatment also aims to enhance the body’s defenses strengthening the individuals’ immune system.

Initially treatment focuses on using acupuncture points on the face and back of the head to expel the Wind and Cold. The acupuncture points that are selected on the face correspond anatomically to the paralyzed facial muscles.

The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).

Complementary therapy...

About 60 - 80% of cases go away completely within a few weeks to months. Sometimes the condition results in permanent changes. The disorder is not life threatening.

Prognosis...

Safety measures may reduce the risk of head injury. Many of the other factors that lead to this disorder are not preventable.

Prevention...

Referance : http://www.emedicine.com , http://www.acupunctureyes.com ,http://www.livestrong.com , ....