Bell's palsy or idiopathic facial paralysis[1] is a dysfunction of cranial nerve VII (the

facial nerve) that results in inability to control facial muscles on the affected side. Several
conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease.
However, if no specific cause can be identified, the condition is known as Bell's palsy.

Bell's palsy is characterized by facial drooping on the affected half, due to malfunction of
the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is
typified by inability to control movement in the facial muscles. The paralysis is of the
infranuclear/lower motor neuron type.

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to
one of the facial nerves. It is the most common cause of facial paralysis. Generally,
Bell's palsy affects only one of the paired facial nerves and one side of the face, however,
in rare cases, it can affect both sides. Symptoms of Bell's palsy usually begin suddenly
and reach their peak within 48 hours. Symptoms vary from person to person and can
range in severity from mild weakness to total paralysis. These symptoms include
twitching, weakness, or paralysis, drooping eyelid or corner of the mouth, drooling, dry
eye or mouth, impairment of taste, and excessive tearing in the eye

Bell's palsy weakens or paralyzes the muscles on one side of the face. When something is
paralyzed, it can't move, so half of the person's face might look stiff or droopy. The
paralysis does not last forever, but someone who has it will have trouble moving one side
of his or her face.

Bell's palsy can develop over a matter of days. Because it can happen suddenly, someone
might think the problem is a stroke — when a blood vessel in the brain gets clogged or
bursts. Like Bell's palsy, a stroke can paralyze a person's face. But Bell's palsy is caused
by nerve trouble and isn't as serious as a stroke. Bell's palsy can be scary, but it usually
doesn't last long and goes away without treatment.

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 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.