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Bells Palsy

Anwar Wardy W ( 07.30-08.20 )


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Types of Cranial Diseases


Bells Palsy Trigeminal Neuralgia Conjugate Gaze Palsies Glossopharyngeal Neuralgia Hemifacial Spasm Hypoglossal Nerve Disorder

Internuclear Ophthalmoplegia Palsies of cranial nerve that controls eye movements Acoustic Neuroma Facial Nerve Meniere Disease Vertigo and Dizziness

Dokter dengan Tingkat kemampuan 4.


Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan penunjang lain yang diminta oleh dokter (Lab.dan X-rays)

Dapat memutuskan dan mampu menangani problem ini secara mandiri sampai tuntas.
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Bell Palsy

WHAT IS BELLS PALSY?


Bells palsy is the most common facial paralysis. Bell's palsy is a form of temporary facial paralysis resulting from trauma to one of the two facial nerves. It is resulted by the damage of 7th cranial nerve. In general, Bell's palsy affect only one of the paired facial nerves and one side of the face, yet, in rare cases, it can affect both sides. The term Bells Palsy is coined by Sir Charles Bell

TERJEMAHAN
Bell's palsy adalah kelumpuhan wajah yang paling umum. Bell's palsy merupakan bentuk wajah kelumpuhan sementara akibat trauma pada salah satu dari dua saraf wajah. Hal ini disebabkan oleh kerusakan saraf kranial 7. Secara umum, Bell's palsy mempengaruhi hanya salah satu saraf wajah pasangan dan satu sisi wajah, tetapi, dalam kasus-kasus yang jarang terjadi, dapat mempengaruhi kedua belah pihak. Istilah Bell Palsy adalah diciptakan oleh Sir Charles Bell
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Causes Of Bells Bells palsy causes significant facial deformation. Most scientists Palsy

believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex-- causes the disorder when the facial nerve swells and becomes inflamed in reaction to the infection. Bell's palsy involves damage to the seventh cranial (facial) nerve that controls the movement of the muscles of the face. Other conditions, such as sarcoidosis, diabetes, and Lyme disease, are associated with Bell's palsy.

Bell's palsy menyebabkan deformasi wajah signifikan. Kebanyakan ilmuwan meyakini bahwa infeksi virus seperti meningitis virus atau virus sakit umum dingin - herpes simpleks menyebabkan gangguan ketika saraf wajah membengkak dan mengalami peradangan sebagai reaksi terhadap infeksi. Bell's palsy melibatkan kerusakan pada kranial ketujuh (wajah) saraf yang mengendalikan gerakan otototot wajah. Lain kondisi, seperti sarcoidosis, diabetes, dan penyakit Lyme, berhubungan dengan Bell's palsy.
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Prevalence of Bells Palsy


Increased with age Overall: 0.5 per year per 1,000 Age 20: 0.1 per year per 1,000 Age 80: 0.6 per year per 1,000

Bell's palsy affects about 2 in 10,000 people

Meningkat dengan usia Secara keseluruhan: 0,5 per 1.000 per tahun Umur 20: 0,1 per tahun per 1.000 Umur 80: 0,6 per tahun per 1.000 Bell's palsy mempengaruhi sekitar 2 dalam 10.000 orang

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VII = Facial Nerve


Motor portion facial muscles salivary & nasal and oral mucous glands & tears
Sensory portion taste buds on anterior 2/3s of tongue
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Motor bagian otot facial liur & mukosa hidung dan mulut kelenjar & air mata

Sensory bagian rasa kuncup pada s anterior 2 / 3 'lidah

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Facial Nerve

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Muscles of facial expression: Associated with (1) the forehead, (2) orbit, (3) mouth, and nose.
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Cutaneous Innervation of the Face

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Bells Palsy
Characterized by:
Peripheral facial paralysis Acute benign cranial polyneuritis Acute disorder characterized by a disruption of the motor branches of cranial nerve VII on one side of the face. (in absence of stroke)

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Dicirikan oleh: Peripheral kelumpuhan wajah Polyneuritis kranial akut jinak gangguan akut dicirikan oleh gangguan dari cabang motor saraf kranial VII di salah satu sisi wajah. (Dalam ketiadaan stroke)

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Bells Palsy
Can affect any age group, though more common from 20-60. Etiology unknown; though reactivated herpes simplex may be involved. Reactivation causes edema, inflammation, ischemia, and eventual demyelination of the nerve, creating pain and alteration in motor and sensory function.

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Dapat mempengaruhi kelompok umur, meskipun lebih umum 20-60. Etiologi tidak diketahui, meskipun diaktifkan kembali herpes simplex mungkin terlibat.

Reaktivasi menyebabkan edema, inflamasi, iskemia, dan akhirnya demyelination saraf, menciptakan rasa sakit dan perubahan pada motor dan fungsi sensor.

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Clinical Manifestations
Benign, with 85% of people recovering in 6 months-remaining 15% have some asymmetry of facial muscles

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Jinak, dengan 85% orang pulih dalam 6 bulan-sisa 15% memiliki beberapa asimetri otot wajah

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Clinical manifestations
Often accompanied by an outbreak of herpes vesicles in or around the ear.

Pain around or behind the ear


Fever, tinnitus, hearing deficits Flaccidity of the affected side of the face with drooping of the mouth accompanied by drooling DT paralysis of the facial nerve (motor branches)

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Sering disertai dengan wabah vesikula herpes dalam atau di sekitar telinga. Sakit di sekitar atau di belakang telinga Demam, tinnitus, pendengaran defisit Keadaan normal dari sisi yang terkena wajah dengan terkulai dari mulut disertai kelumpuhan drooling DT dari saraf wajah (cabang motor)

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Clinical manifestations
Inability to close the eyelids, with an upward movement of the eyeball when closure is attempted; lower lid may turn out Wide palpebral fissure (opening between eyelids) Flattening of the nasolabial fold Inability to smile, frown, or whistle Unilateral loss of taste Altered chewing ability; loss of or excessive tearing
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Complications
Psychological withdrawal DT changes in appearance,malnutrition or dehydration, mucous membrane trauma, corneal abrasion, muscle stretching, and facial spasms and contractures.

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Diagnostic Studies
Diagnosis made on basis of symptoms in the absence of other causes of paralysis such as stroke. No definitive test EMG may determine nerve excitability or absence

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Therapeutic Management
Corticosteroids- drug of choice

Prednisone may be started immediately!


Best if initiated before paralysis is complete Taper off over 2 weeks Decrease edema and pain Analgesics may be needed for pain Antivirals : Acyclovir (Zovirax) and Famvir because HSV is implicated in 70% of cases.
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References
Adour KK et al: Bells Palsy Treatment with Acyclovir and Prednisone Compared with Prednisone Alone: Double Blind Randomized Controlled Trial. Ann Otol Rhinol Laryngol 105:371, 1996 Barrows, RW: Drug Induced Neuromuscular Blockade and Myasthenia Gravis. Pharmacotherapy 17:1220, 1997 Fauci, AS et al : Harrisons Principles of Internal Medicine. 1998 Kleiner-Fisman, G, Kott HS: Myasthenia Gravis Mimicking Stroke in Elderly Patients. Mayo Clin Proc 73:1077, 1998 Moore, MR et al: Disorders of Porphyrin Metabolism. 1987 Tintinalli, JE et al Emergency Medicine A Comprehensive Study Guide. 2000 van der Meche FGA, Schmitz PIM, and the Dutch Guillan-Barre Study Group: A Randomized Controlled Trial Comparing Intravenous Immune Globulin and Plasma Exchange in Guillan-Barre Syndrome. N Engl J Med 326:1123, 1992
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Thank You

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