bell's
palsy
college of nursing | Angeles University Foundation
what is bel's palsy?
Bell palsy is the most common peripheral paralysis of the seventh cranial
nerve with an onset that is rapid and unilateral. It begins suddenly and
worsens over 48 hours. This is an idiopathic condition causing partial
or complete weakness of one half of the face along with changes in taste,
sensitivity to sound and alteration in lacrimation and salivation. It is the
most common cause of unilateral facial paralysis. It is more common in
patients with diabetes mellitus and in pregnant females.
causes risk factors
It is equal for both sex. It most commonly occurs
Cold sores and genital herpes (herpes simplex)
between the ages of 15 and 60 years. About 1 in
Chickenpox and shingles (herpes zoster)
60 people have a Bell's palsy at some stage in
Infectious mononucleosis (Epstein-Barr)
their life. You're at high risk if you:
Cytomegalovirus infections
Respiratory illnesses (adenovirus)
Are pregnant
German measles (rubella)
Have a family history of the condition
Mumps (mumps virus)
Have diabetes
Flu (influenza B)
Have a lung infection
Hand-foot-and-mouth disease (coxsackievirus)
SIGNS AND SYMPTOMS
CRANIAL NERVE 7 DROOLING PTOSIS HEARING LOSS
DRYNESS(MOUTH) FACE TWITCH NUMBNESS EXCESS TEARS
CN VII is a mixed cranial nerve with motor, sensory, and Drooping of the eyelid and corner of the mouth: Bell's palsy
autonomic function: 50% to 60% have pain around and behind the temporarily weakens or paralyzes facial muscles. They develop a
ear and neck. Most often these symptoms begin suddenly and reach droopy appearance on one — or sometimes both — sides of the
their peak within 48 to 72 hours. face.
Drooling: Bell's palsy temporarily weakens or paralyzes facial Hearing loss: This nerve lies within the internal ear canal. Pressure
muscles. The nerve damage may also affect your sense of taste and on this nerve results in the early symptoms of acoustic neuroma, a
how you make tears and saliva. ringing sound in the ear
Dryness of the eye or mouth: Weakness of these muscles can
Facial numbness: Many patients also experience tongue
make it difficult to smile or close the eye. In some cases, you may
numbness, a metallic taste in the mouth, and irritation in one eye
lose the normal ability to close one eye, which can lead to drying of
from not being able to close it all the way.
the surface of the eye (the cornea).
Facial twitching: Facial spasm, a very rare complication of Bell
palsy, occurs as tonic contraction of 1 side of the face. Spasms are Excessive tearing in 1 eye :The upward rotation of the eye when
more likely to occur during times of stress or fatigue and may be attempting to close the eyelids is known as Bell's Phenomenon.
present during sleep.
complication
Irreversible damage to facial nerves.
Abnormal regrowth of nerve fibers. This may result in involuntary contraction of
certain muscles when you're trying to move others (synkinesis) — for example,
when smiling, the eye on the affected side may close.
Partial or complete blindness of the eye that won't close due to excessive dryness
and scratching of the clear protective covering of the eye (cornea).
BELL'S PALSY
LABORATORY PROCEDURES
There's no specific test for Bell's palsy. Your doctor will look at your face and ask you to move your facial
muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
COMPLETE BLOOD
PHYSICAL
COUNT TEST
ASSESSMENT
To help in diagnosing other concurrent problems
To know the extent of the weakness such as infections, diabetes or other diseases that
in your facial muscles. It involves are often linked to Bell's palsy.
examining for upper and lower
Nursing interventions:
facial weakness or paralysis on one
1. Obtain informed consent
side of you face including the 2. Inform the patient that some discomfort might
forehead, eyelid, and/or mouth. be experienced when the needle is inserted.
3. Instruct to not pull the hands during the
procedure.
MRI OR CT SCAN ELECTROMYOGRAPHY
To help rule out other structural causes of paralysis To confirm the presence of nerve damage and
or pressure on the facial nerve it severity and the determine the severity of the extent of nerve
extent of nerve involvement. involvement.
Nursing interventions: Nursing interventions:
1. Obtain informed consent 1. Obtain informed consent.
2. Assess for allergies to iodine contrast, dyes or 2. Instruct the patient to avoid using creams or
shellfish if a dye is used lotions on the day of the test.
3. Assess the client is pregnant. The temperature of 3. Instruct the patient to avoid smoking and drinking
the amniotic fluid may rise during the procedure caffeine for 3 hours before the procedure.
and may be harmful to the fetus 4. Avoid administration of muscle relaxants
4. Remove all metal objects from the client anticholinergic and cholinergic agents for 3-5 days
5. Instruct to increase fluid intake if a contrast before the test.
medium is used.
medical management
Corticosteroid
Therapy ACYCLOVIR
(ZOVIRAX)
traditionally been prescribed to
reduce facial nerve inflammation steroid therapy that treats
1. Monitor any signs of infections caused by the herpes virus,
peptic ulcer, including including cold sores, genital herpes.
heartburn, nausea, Mild Analgesics
vomiting, blood tarry
stools, and loss of Assess skin and mucosal lesions to
acetaminophen (pain reliever and help determine if drug therapy is
appetite
fever reducer) successful in controlling the
2. Assess for increased
non-steroidal anti-inflammatory infection
intracranial pressure in
drugs may relieve any pain Monitor for pain swelling and
children including irritation
changes in 1. Monitor renal function Monitor signs of purpura and
consciousness and 2. Monitor for side effects such hemolytic-uremic syndrome (Report
vomiting . as headache dizziness or signs to the physician immediately)
3. after a meal. epigastric pain
3. Instruct the patient to take
with meals or with milk.
surgical management
ELECTRICAL SURGICAL FACIAL N.
STIMULATION EXPLORATION DECOMPRESSION
May be applied to the face It may be indicated if Facial nerve
to prevent muscle decompression is
the tumor is
weakness.
suspected for generally performed
Nursing Responsibilities surgical after other less invasive
1. Obtain informed decompression of treatments for the
consent
the facial nerve or for symptoms of facial
2. Instruct the patient palsy have been
about the procedure a surgical treatment
attempted.Optimal
3. Inform and educate of a paralyzed face.
the patient that will be
result after facial nerve
placed on the surgery is seen about 1
ipsilateral muscle to year after treatment
stimulate the anode.
NEED TO KNOW FACTS!
BELL'S PALSY
To Prevent?
Bell's palsy is not considered permanent, but in
rare cases, it does not disappear. Currently, there
is no known cure for Bell's palsy; however,
recovery usually begins 2 weeks to 6 months from
the onset of the symptoms. Most people with
Bell's palsy recover full facial strength and
expression.
How What
Is the prognosis for Bell's
Palsy patients
If the nerve damage is mild,
you may start seeing an
When improvement within 2 to 3
weeks of the initial onset of
symptoms. If the nerve
damage is more severe, it
could take 3 to 6 months to
start noticing an improvement.
In rare cases, symptoms may
continue to return or may be
permanent.
When to see a doctor, who to contact?
Bell's palsy is not caused by a stroke, but it can cause similar
symptoms.Seeing a doctor should be initiated if the client experiences
new Bell’s palsy symptoms
Diagnosis is usually determined by a neurologist who will examine the
patient's facial movements and look for any inconsistencies that may
be caused by Bell's Palsy. If necessary, for more severe cases, an MRI
test can be performed to determine what pressure, if any, there is on
the facial nerves.
References:
Mayo Clinic. (n.d.). Bell's palsy - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/bells-
palsy/symptoms-causes/syc-20370028
UpToDate. (n.d.). https://www.uptodate.com/contents/bells-palsy-beyond-the-basics#H2
Bell's Palsy - Diagnosis and treatment - Mayo Clinic. (2020, April 2). Retrieved from
https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034
Warner MJ, Hutchison J, Varacallo M. Bell Palsy. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482290/
