Lecture#02 ___fascial palsy

Dr.FOUZIA BATOOL PT.PP-DPT Lecturer, RCRS

Facial Nerve

Facial nerve is a mixed nerve, having a motor root and a sensory root. Motor root supplies all the mimetic muscles of the face which develop from the 2nd brachial arch.7th cranial nerve supplies all the muscles concerned with facial expression Small sensory component; conveys taste sensation from the anterior 2/3 of the tongue Motor nucleus of 7th nerve lies anterior and lateral to the abducents nucleus

Cont

Saunderland classification:
1: Partial block: Neuropraxia 2: Loss of axons: axonotemesis 3: Injury to the endoneurium: neurotemesis 4: Injury to the perineurium: partial transection 5: Injury to the epineurium: complete transection

Facial Nerve
Each nerve controls:
Eye blinking and closing Facial expressions
Smiling and frowning

Tear glands Saliva glands Muscle of small bone in middle of ear called the stapes Taste sensations

What Causes This?

It occurs when the facial nerve is swollen, inflamed, or compressed

The Most Common Form of Facial Paralysis is idiopathic -Bells Palsy

S/S

Varies from person to person

Comes on suddenly Mild to total paralysis
Weakness, twitching on one of both sides of the face

Facial and eyelid droop Drooling Dryness of eye or mouth Impairment of taste Excessive tearing of eye

Other S/S

Pain or discomfort in jaw and behind the ear Ringing in one or both ears Loss of taste Headache Hypersensitivity to sound Impaired speech Dizziness Difficulty eating and drinking

Cont
Speaking, Whistling impaired Non-verbal communication is lost as patient cannot register pleasure, laughter, Surprise, interest or worry The patient tends to sit with the hand over the side of the face

Cont

Bell's phenomenonupward diversion of the eye on attempted closure of the lidis seen when eye closure is incomplete.

Bells Palsy

For some, however, the symptoms may last longer

In a few cases, the symptoms may never completely dissapear

Treatment
Studies have shown that steroids are probably the most effective treatment Acyclovir combined with prednisone is possibly effective in improving facial function

Physical Therapy Management

Exercises: o Look surprise then frown o Squeeze eyes closed then open wide o Smile, grin, say O o Say a,e,i,o,u o Hold straw in mouth, blowing with Balloons o Whistle

Electrical Stimulation
Galvanic

Current Faradic Current

Motor Point

Maximum response is obtained either from stimulation at the motor point Optimum Contraction MOTOR POINT is a point at which the main nerve enters the muscle Region in a muscle where great density of terminal motor end plates are found near the surface.

Not necessarily correspond with the point where the nerve enters a
muscle. Vary from individual to individual. Generally situated in the belly of the muscle or in the middle of longitudinal axis.

Stimulation at junction of upper and middle one third of the fleshy belly of muscle

Motor points of FACE

Frontalis: about halfway between hairline and centre of eyebrow. (horizontal wrinkling) Corrugator: above the outer third of superciliary arch (vertical wrinkling) Orbicularis oculi: just below and lateral to outer angle of eye (closure of eye) Nasalis: just above ala of nose (produces wrinkle over nose)

Cont

Orbicularis oris: upper point can be located at about halfway between angle of mouth and tip of nose and the lower point approximately in the same position below mouth (closing of lips) Risorius: about one fingers breadth lateral to the angle of mouth (smiling) Buccinator: about two finger width lateral to the angle of mouth (blowing) Mentalis: midline near prominence of chin (wrinkling of chin)

THE END