BELL’s PALSY

• It is an acute, acquired, non traumatic , unilateral, infranuclear facial palsy
• It causes a temporary weakness or paralysis of the muscles in the face and occurs when the nerve that controls facial muscles becomes inflamed, swollen, or compressed
• The onset of Bell’s palsy is usually abrupt. Pain behind the ear may be present prior to the paralysis
• Although Bell’s palsy can occur at any age, the condition is more common among people between ages 16 and 60. Bell’s palsy is named after the Scottish anatomist Charles Bell, who was the first to describe the condition

Although the exact reason for Bell's palsy is not clear, it is often related to having a viral infection. Viruses that have been linked to Bell's palsy include viruses that cause:

• Cold sores and genital herpes (herpes simplex)
• Chickenpox and shingles (herpes zoster)
• Infectious mononucleosis (Epstein-Barr)
• Cytomegalovirus infections
• Respiratory illnesses (adenovirus)
• German measles (rubella)
• Mumps (mumps virus)
• Flu (influenza B)
• Hand-foot-and-mouth disease (coxsackievirus)

The nerve that controls facial muscles passes through a narrow corridor of bone on its way to the face. In Bell's palsy, that nerve becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of ear

Risk factors

• Pregnancy, especially during the third trimester, or the first week after giving birth
• Upper respiratory infection, such as flu or a cold
• Diabetes

• The most common symptoms are pain in and around the ear along with facial weakness
• Abrupt onset, maximum weakness attained by 48 hrs
• Pain behind ear precede by paralysis for a day or two
• Unilateral loss of taste sensation
• Hyperacusis
• Flaccid paresis of all facial mimetic muscles on the involved side
• Affected side is smooth, the brow droops, and the cheek balloons on expiration
• Lagophthalmus and Bell’s phenomenon( on attempted closure, the globe turns up and out)
• Lower lid is everted with excessive tearing
• Various facial reflexes are lost
• Proximal lesions to geniculate ganglion affect taste sensation, lacrimation and stapedial reflex, while distal lesions cause only muscle weakness
• 80% patient recover within few weeks or months
• Presence of incomplete paralysis in the 1^st week is the most favourable prognostic sign

Differential Diagnosis

• Lyme disease : Unilateral/bilateral facial palsy
• Ramsay Hunt syndrome: Due to reactivation of Herpes Zoster virus in geniculate ganglion. There will be Severe facial palsy with vesicular eruption in external auditory canal, sometimes pharynx
• Melkersson – Rosenthal syndrome: Recurrent facial paralysis with recurrent and permanent facial edema and placation of tongue

Diagnosis made clinically in patients with

Typical presentation

• No risk factors or pre existing symptoms for other causes of facial paralysis
• Absence of cutaneous lesions of herpes zoster in external ear canal
• Normal neurological examination with the exception of the facial nerve

If atypical

• ESR, DM test, Lyme test, angiotensin – converting enzyme, chest imaging studies for possible sarcoidosis
• Lumbar puncture for Guillain – Barre syndrome
• MRI – swelling and uniform enhancement of geniculate ganglion and facial nerve
• CSF - Mild lymphocytosis

• Physiotherapy helps prevent muscles from permanently contracting
• Medications-Steroid and Antiviral drug
• Eye packing is done during sleep
• Measures to prevent corneal drying – artificial tears
• Devices-Eye patch

Internal medicines

• Dhanadanayanadi Kashaya
• Ashtavarga kashaya
• Bhadradarvadi kashaya
• Kapikachu choorna
• Ashwagandha choorna
• Ekanga veera rasa
• Vatavidvamsani rasa
• Ksheera bala taila
• Mahamasha taila
• Aswagandharishta
• Lasuna rasayana

Procedures

• Nasya - ksheerabala / karpasathyadi / Anutaila
• Talam - Navaneetha + Balachoorna / Rasnadi choorna + Nimbamruta eranda taila
• Mukha abhyanga – Karpasathyadi/ Mahamasha taila
• Ksheeradhooma
• Karnapurana
• Siro pichu – Dhanwantara taila / Karpasasthyadi taila
• Siro Vasti – Dhanwantara taila
• Tarpana with satahwadi tarpana ghrita