Marthin Tori
KSM Neurologi RSUD dr. Doris Sylvanus
P.Raya 2018
Introduction
• The condition is named for the
Scottish surgeon who first described
it in the 1800s, Sir Charles Bell
Patel D, Levin K. Bells Palsy :Clinical examintaion and Management. Cleavelnd Clinic Journal of Medicine. July
2015. Vol 82;7
Epidemiology
Cormier J. Bell”s Palsy : A common Cause of Facial Paralysis. Texas EMS Magazine . November/Desember 2012
Anatomy Facial Nerve
Mullen MT, Difereciating Facial Weakness Caused by Bell’s Palsy VS Acute Stroke. JEMS. May 2014
Periperal Facial Palsy
Etiology
The etiology of Bell's palsy is unknown but the
most possible pathomechamism are :
Vascular ischemia
Viral Infection
Autoimmune disease
Greco. A et al. Bell’s Palsy and Autoimmunity. Autoimmunity Reviews 12 (2012) 323-328
Vascular Ischemia
possibly triggered by cold
temperature or
psychosomatically,
Pham V, Young D, Makishima T. Bell's Palsy. Grand Rounds Presentation, Department of Otolaryngology The University
of Texas Medical Branch (UTMB Health). October 2012
Viral Infection
Latent herpes viruses (herpes simplex, herpes zoster) which has
been found postmortem in a collection of cranial nerve fibers
called the geniculate ganglion being reactivated
Kes VB et al. Peripheral Facial Weakness (Bell’s Palsy). Acta Clin Croat 2013;52: 195-202
Immunological hypothesis
Kes VB et al. Peripheral Facial Weakness (Bell’s Palsy). Acta Clin Croat 2013;52: 195-202
Diagnosis
History :
Acute onset of unilateral upper and lower facial
paralysis (over a 48-h period), patient complain a
poor eyelid closure ,aching of the ear or mastoid,
Alteration of taste , Tingling or numbness of the
cheek/mouth and sometimes Blurred vision
History of activity or job that had been done at
night, outside
inquiry on exposure to various viruses (herpes,
chicken pox-varicella zoster, HIV, etc) and history
of stress and cold symptoms.
Physical Examination
Patel D er al. Bell Palsy : Clinical Examination and Managemnet. CCJM. 82: 7. July 2015
Signs and Symptoms
Diagnosis Topis :
Kelainan Gangguan Gangguan Hiposekresi Hiposekresi
Letak Lesi
motorik pengecapan pendengaran saliva lakrimalis
Pons-meatus akustikus
+ + + tuli/hiperakusis + +
internus
Meatus akustikus internus- +
+ + + +
ganglion genikulatum Hiperakusis
Ganglion genikulatum-N. +
+ + + -
Stapedius Hiperakusis
N.stapedius-chorda tympani
+ + + + -
Chorda tympani + + - + -
Infra chorda tympani-sekitar
foramen stilomastoideus + - - - -
Facial Grading System
UGO FISCH
Position Score Persentage (%) Score
0, 30, 70, 100
Resting 20
wrinkle forehead 10
close eyes 30
smile 30
Whistle 10
Total
Medication
Hyperbaric
oxygen
Management
Physiotherapy
Acupuncture
Surgery
Zhao Y et al. Advances in Diagnosis and Non-surgical Treatment of Bells pallsy.Journal of Otology 10
(2015) 7-12
Eye protection
Facial paralysis can lead to eye closure failure,
which, without timely intervention, can result in
corneal ulceration, scarring and vision loss
Antiviral
Steroid
Medication
Tiemstra J, Khatkhate N. Bell’s Palsy: Diagnosis and Management. American Family Physician. Volume 76, Number 7.
Medication
Electric
Biofeedback Mime Play
Stimulation
FACIAL EXERCISES
Take a deep breath through Gently try and move Try and keep the movement the You can use your fingers to
your nose, try and flare nostrils corners of mouth outwards same on each side of your face help. Once in position take
your fingers away and see
if you can hold that smile
Look Down Gently place back of index With opposite hand gently stretch eyebrow up …. working along the
finger on eyelid, to keep brow line. This will help relax the eyelid and stop it from becoming stiff.
the eye closed
Tarsorrhaphy
In rare cases, the disorder may recur, either on the same or the
opposite side of the face
Crocodile tear
phenomenon
Kontraktur Synkinesis
Hemifacial
spasm