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Bells Palsy

anwar wardyNeurolgy, fkk umj

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 NerveDisorder

Internuclear

OphthalmoplegiaPalsies of cranial

nerve that controls

eye movements

Acoustic NeuromaFacial Nerve

Meniere Disease

Vertigo and

Dizziness

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Dokter dengan Tingkat

kemampuan 4.Mampu membuat diagnosis klinikberdasarkan pemeriksaan fisik dan

penunjang lain yang diminta olehdokter (Lab.dan X-rays)

Dapat memutuskan dan mampu

menangani problem ini secaramandiri sampai tuntas.

anwar wardy wfkk umj

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Bell Palsy

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WHAT IS BELLS PALSY?

Bells palsy is the most common facial paralysis.Bell's palsy is a form of temporary facial paralysisresulting from trauma to one of the two facialnerves. It is resulted by the damage of 7th cranial

nerve. In general, Bell's palsy affect only one ofthe 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

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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 inidisebabkan 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

PalsyBells palsy causes significant facial deformation. Most scientists

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 Lymedisease, are associated with Bell's palsy.

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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 otot-otot wajah. Lain kondisi, seperti sarcoidosis,

diabetes, dan penyakit Lyme, berhubungan

dengan Bell's palsy.


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Prevalence of Bells

PalsyIncreased with ageOverall: 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

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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 1.000Bell's palsy mempengaruhi sekitar 2 dalam

10.000 orang


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VII = Facial Nerve

Motor portion

facial muscles

salivary & nasaland oral mucous

glands & tears

Sensory portion

taste buds on

anterior 2/3s of

tongue

fkk umjanwar wardy w

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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

fkk umjanwar wardy w

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anwar wardy

Facial Nerve
http://education.yahoo.com/reference/gray/subjects/subject?id=202

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anwar wardy

Muscles of facial expression: Associated with (1)

the forehead, (2) orbit, (3) mouth, and nose.

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anwar wardy

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 causesedema, inflammation,ischemia, and eventualdemyelination of the

nerve, creating painand alteration in motorand 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, menciptakanrasa 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

http://www.homeomiracles.com/Index/Nervous/Nervous_article/Bells%20palsy/Bells_face.gif

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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 ofherpes vesicles in or around the ear.

Pain around or behind the ear

Fever, tinnitus, hearing deficits

Flaccidity of the affected side of the facewith drooping of the mouth accompanied

by drooling DT paralysis of the facialnerve (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 upwardmovement of the eyeball when closure isattempted; lower lid may turn out

Wide palpebral fissure (opening betweeneyelids)

Flattening of the nasolabial fold

Inability to smile, frown, or whistle

Unilateral loss of taste

Altered chewing ability; loss of or excessivetearing


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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 iscomplete

Taper off over 2 weeks

Decrease edema and painAnalgesics may be needed for pain

Antivirals : Acyclovir (Zovirax) and Famvirbecause HSV is implicated in 70% ofcases. anwar wardyNeurolgy, fkk umj

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anwar wardy

References

Adour KK et al: Bells Palsy Treatment with Acyclovir and Prednisone Compared with

Prednisone Alone: Double Blind Randomized Controlled Trial. Ann Otol Rhinol

Laryngol105:371, 1996

Barrows, RW: Drug Induced Neuromuscular Blockade and Myasthenia Gravis.

Pharmacotherapy17:1220, 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 alEmergency 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 Med326:1123, 1992

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anwar wardy

Thank You

1.a.bells palsy 01

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