NA2-CN lesions: Bell's Palsy

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Author:
agatton
ID:
21848
Filename:
NA2-CN lesions: Bell's Palsy
Updated:
2010-06-03 00:20:51
Tags:
wccmt
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Description:
Bell's Palsy
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  1. Bell's Palsy
    • Lesion of CN 7 (facial)
    • Flaccid paralysis of the MMs of facial expression (usually) on the same side as the (brain) lesion
    • Bilateral if lesion in barin, Unilateral if it's a NN lesion
  2. Causes of Bell's Palsy
    • Compression from edema (pregs, mid ear infection, diabetes, hypertension, hypothyroid)
    • Conditions effecting parotid (mumps, cancer, chaw)
    • Compression from inflamation (trauma)
    • Exposure to chill
    • Genetics
  3. Bell's Palsy S&S
    (10)
    • Unilateral flaccid paralisis of facial MMs
    • Incomplete eye closure => eye patch
    • Loss of blink reflex => tearing
    • Can't whistle
    • Difficulty articulation sounds
    • Dribbly-drinking
    • Increase/Decrease of salivation or lacrimation
    • Loss of or altered sense of taste
    • Heightened sensitivity to low tones
    • Pain
  4. The Branches of CN 7
    (6)
    • Temporal
    • Zygomatic
    • Buccal
    • Mandibular
    • Cervical
    • Post Auricular
  5. The CN 7 branches supply:
    (6)
    • Temporal: Orbital MMs, but not Lev Palp Sup
    • Zygomatic: Zygoma, Orbital and Intraorbital area
    • Buccal: Buccinator MM and Upper Lip
    • Mandibular: Lower lip and Chin MMs
    • Cervical: Platysma, Stylohyoid, Post digastric MMs
    • Post Auricular: Occipitalis MM

    • Also, another division:
    • Ant 2/3 of tongue
    • salivary glands
    • lacrimal glands
    • Soft palate
    • external auditory meatus
  6. Pathway of CN 7
    Brainstem => Exteranl Surface (usually) of the cranium => Emegerges thru stylo-mastoid foramen => thru parotid gland => crosses external carotid AA, divides behind ramus of lower jaw (temporo-facial and cervico-facial) => further divide into six branches
  7. Special Tests for Bell's Palsy
    (3)
    • 1. Chvostek's Sign: "Clench Jaw" => palp masseter, move ant => "relax" => tap the NN
    • + is wincing
    • 2. Facial MM expression testing: Make faces
    • + if there is MM paralysis
    • 3. Sensory testing: "Close eyes" => test skin sensation w/ kleenex
    • + if no sensation is reported
  8. Tx goals for Bell's Palsy
    • D. Breathing
    • Dec. SNS firing, Edema, Pain
    • Tx comps (HT + TrP of neck MMs etc)
    • Maintain Tissue health
    • Prevent contracture

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