HLTH213 Anatomy Of Head, Neck And Trunk

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Question:

Topic: Bells Palsy

Here’s a link to the topic:

It is important to outline the pathology and epidemiology of this topic.

Please describe the relationship between the presentation and symptoms of this condition and the pathology. (e.g. what is the normal function of the structure in your topic? and how is it being affected).

The pathology and its effects on surrounding structures can be compared.

Briefly explain the most frequent interventions and prognosis to the patient.

Answer:

Introduction

Bell’s Palsy can cause partial facial paralysis due to rheumatism.

It is the most common reason for unilateral or severe facial paralysis. The incidences vary depending on where they are located.

It can cause muscle weakness on the forehead and one side of the head, resulting in a droopy face.

The condition can last for three days, however there are no other neurologic abnormalities (Bell’s Palsy – Topic Summary n.d.).

Partial paralysis may affect the senses of taste and normal functioning salivary (tears-producing) systems.

Bell’s Palsy Pathology and Epidemiology

Bell’s Palsy was named after Sir Charles Bell. He described the syndrome and explained the anatomy and function the facial nerve. However, it affects male sex in equal amounts. Bell’s Palsy tends to be more common in younger females than in men.

It is often seen that cases of right-side palsy are more common (63% more) than left-side palsy.

However, bilateral palsy can also exist but is very rare. Bell’s Palsy is responsible 22% of all Bilateral Palsy.

Large population surveys suggest that the incidence rate is between 15 and 30 cases per 100,000.

Bell’s Palsy is also more common in certain geographical areas.

Japan is the country with the highest incidence and Sweden, the least (Mestrovi?)

Because Bell’s Palsy is a supposedly idiopathic condition, the exact pathophysiology remains elusive.

Several literature resources mention that Bell’s Palsy is more likely to be caused by an infection of Herpes Simplex Virus 1 (HSV-1).

Patients with diabetes, upper respiratory problems and migraine are also susceptible.

It can also affect pregnant women in their third trimester.

As far as the mechanism behind the occurrence and progression of disease, the seventh cranial nervous passes through a portion of the temporal bone known as the facial canal. It is located close to the upper jaw.

The facial nerve is affected by inflammation. It causes compression in the facial channel, which in turn results in a reduction in neural signal transmission in facial neurons.

Bell’s Palsy Presentation and Symptomatology

Bell’s Palsy usually occurs when facial weakness and muscle weakness are present.

The appearance of a nasolabial fold disappears along with a forehead unfurrow, a weakening of the facial muscles and a drooping corner.

These symptoms can give rise to the fear of stroke or a brain tumor.

Motor deficit in the upper and/or lower facial regions affected is the most common symptom.

Many patients complain of ipsilateral headaches and inability to close their eyes.

Bell’s effect occurs when the eyes roll upwards after an attempt to close them.

Bell’s effect is the reason that eye irritation is common. This happens because of continued exposure to light and lack of lubrication.

Some patients also experience tinnitus, hyperacusis and numbness in the ears, tongue, and face.

Taste sense and lacrimation are also affected by the effects on the tongue.

Although tear production is reduced due to the permanent opening in the eyelids, it is impossible to stop the free flow of tears.

Another less-known effect is the psychological one. This can have a detrimental effect on the individual’s social competences (Zandian, Tiemstra & Khatkhate 2007.

Bell’s Palsy diagnosis can be described as a technique of exclusion. This is where doctors check for different causes and symptoms that could cause facial paralysis. They then list them all, leading to Bell’s Palsy.

You can order an Electromyogram, MRI or CT Scans to be sure (Nordqvist 2017.

Relationship Between Bell’s Palsy Pathology and Surrounding Structures

The exact pathological effects of Bell’s Palsy on surrounding structures cannot be determined because there is not a clear underlying cause.

There are cases in which HSV-1 viral infections were present earlier. Researches show that the latent virus travels along facial nerves and settles in the geniculate ganglion, where it remains latent for a longer time and activates later to cause neurodegeneration (Mestrovi).

The disease causes hyperacusia, Tinnitus, and ear pain in the nearby lying ear.

It also affects the tongue by causing loss of taste sensations and numbness. Additionally, it affects the eyes by reducing motor control in the eyelids and lacrimation.

Most Common Interventions and Prognosis For Patients, including Common Complications

Bell’s Palsy is a condition that causes symptoms to subside if left untreated.

In a study, up to 85% of patients recovered their functions within three weeks. Only 71% achieved complete spontaneous recovery.

Other cases may show signs of permanent facial disfiguration or persistent lacrimation.

Bell’s Palsy is affected by several prognostic factors. These include age, severity of facial nerve compression, degree of inflammation, facial paralysis, and promptness in treating the symptoms.

Bell’s Palsy can be treated using antivirals, Corticosteroids and surgical treatment. Some cases may result in hearing loss.

Bell’s Palsy complications include Sequelae (synkinesis), crocodile tears syndrome, incomplete motor recovery, facial asymmetry and muscular contractures, as well as incomplete sensory regeneration such dysesthesia and dysgeusia (Mestrovi?)

Conclusion

Bell’s Palsy can be a common condition, but its pathology is still a mystery even after over a century of literary information.

Although the clinical presentation of Bell’s Palsy is well documented, its diagnosis is still exclusionary due to lack of differential features from other forms of facial paralysis.

It can cause serious complications over time, but most cases of Bell’s Palsy can be treated spontaneously.

References

Bell’s palsy management and diagnosis, Am Fam Physician, vol.

Zandian A. Osiro S. Hudson R. Ali IM, Matusz P. Tubbs SR Loukas M 2014.

The neurologist’s dilemma: A comprehensive clinical overview of Bell’s palsy and emphasis on current management strategies’, Medical Science Monitor vol.

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