Management of Bell’s Palsy

BELL’S PALSY

Bell’s Palsy (facial paralysis) is due to peripheral involvement of the seventh cranial nerve on one side, which results in weakness or paralysis of the facial muscles. The cause is unknown, but possible cause may include vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or a combination. Bell’s palsy may represent a type of pressure paralysis in which ischemic necrosis of the facial nerve causes a distortion of the face, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye. The patient may experience speech difficulties and may be unable to eat on the affected side owing to weakness.

MEDICAL MANAGEMENT

The objectives of management are to maintain facial muscle tone and to prevent or minimize denervation. Steroidal therapy may be initiated to reduce inflammation and edema, which reduces vascular compression and permits restoration of blood circulation to the nerve. Early administration of corticosteroids appears to diminish severity, relieve pain, and minimize denervation. Facial pain is controlled with analgesic agents or heat applied to the involved side of the face. Additional modalities may include electrical stimulation applied to the face to prevent muscle atrophy, or surgical exploration of the facial nerve. Surgery may be performed if a tumor is suspected, for surgical decompression of the facial nerve, and for surgical rehabilitation of a paralyzed face.

NURSING MANAGEMENT

Patients need reassurance that a stroke has not occurred and that spontaneous recovery occurs within 3 to 5 weeks in most patients. Teaching patients with Bell’s palsy to care for themselves at home is an important nursing priority.

TEACHING EYE CARE

Because the blink reflex is diminished, the involved eye may not close completely and the needs to be protected to prevent corneal irritation and ulceration. Inform the patient of potential complications, including corneal irritation and ulceration, overflow of tears, and absence of blink reflex. Key teaching points include:
· Cover the eye with a protective shield at night.
· Apply eye ointment to keep eyelids closed during sleep.
· Close the paralyzed eyelid manually before going to sleep.
· Wear wrap-around sunglasses or goggles to decrease normal evaporation from the eye.

TEACHING ABOUT MAINTAINING MUSCLE TONE

· Show patient how to perform facial massage which gentle upward motion several times daily when the patient can tolerate the massage.
· Demonstrate the facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling in an effort to prevent muscle atrophy.
· Instruct patient to avoid exposing the face to cold and drafts.
· Remind patient and family of the importance of participating in health promotion activities and recommended health screening practices.


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