NEUROLOGY

BELL’S PALSY
By Group 1
MEMBERS
 Himami Firdausiyah (6130014001)
 Imam Fadli (6130014006)
 Badiatul Khilqoh (6130014011)
 Nuris Umi Rizqi (6130014016)
CASE
a 20-year-old woman came in a general practitioner’s poly complaining of
numbness on the cheek and right ear. overnight before a complaint arose, the patient
said to go home late at night to motorcycle after doing group work. then sleeping on the
floor wearing a fan that leads continuously to her face. after waking up, when the
patient looks in the mirror the face is not symmetrical to the left when smiling. the
patient also complains that the right eyelid can not be closed, the tears from the right
eye keep coming out and the pain behind the right ear. patients complain of difficulty
rinsing and drinking with straws. talk no abnormalities. there is no weakness of the limb
on the left side. vital sign is normal
 CASE
physical examination
the general condition is normal, good conscious, GCS 456, blood pressure 120/70 mmHg, pulse
88x / min regular, normal thorax examination, normal abdominal examination.
Other neurological examinations: no meningeal stimuli (meningeal sign -), talk no abnormality
(dysarthria -). there is no weakness of the limb on the left side (hemiplegia sinistra -).
 
PROBLEM LIST
 A woman 20 years old
 numbness on the cheek and right ear
 to go home late at night to motorcycle
 sleeping on the floor
 wearing a fan that leads continuously to her face
 face is not symmetrical to the left when smiling
 the right eyelid can not be closed
 the tears from the right eye keep coming out
 the pain behind the right ear
 difficulty rinsing and drinking with straws.
HYPOTHESIS
From anamnesis, physical examination and facial nerve examination, obtained during
the inspection: the face is not symmetrical to the left, while smiling eyebrows left
behind, the right eye can not close, when smile nasolabial folds are not formed,
allegedly experiencing bell's palsy.
MIND MAP
LEARNING OBJECTIVES
1. Can explain the anatomy and physiology of the facial nerve
2. can explain the etiology of bell's palsy
3. can explain the clinical manifestations of bell's palsy
4. can explain the differential diagnosis of bell's palsy
5. can explain how to diagnose bell's palsy
6. can explain the management of bell's palsy
7. can explain the complications of bell's palsy
8. can explain the prognosis of bell's palsy
 ANATOMY OF FACIAL NERVE
Name Component Origin Function

Facial Branchial  Facial nucleus  Facial expression muscles: M. plates,

nerve efferent m.stilohioideus, m.digastrikus,
m.frontalis, m.orbicularis,
m.buccinator, m.orbicularis oris

Intermedi Visceral efer Superior Nasal, lacrimal, salivary glands

ate nerve en  nucleus (sublingual and submandibular)
salivatorius

  Visceral Ganglion  2/3 anterior tongue tinting

afferent geniculatum 
special
  Somatic Ganglion genik The outer ear, the auditory portion,
afferent  uli  the outer surface of the tympanic
membrane (sensibility)
THE ETIOLOGY OF BELL’S
PALSY
A. Idiopathic
Factors suspected of contributing to Bell's Palsy include: after traveling far in
vehicles, sleeping in the open, sleeping on the floor, hypertension, stress,
hypercholesterolemia, diabetes mellitus, vascular disease, immunologic disorders
and genetic factors.
B. B. Congenital
a. Congenital anomalies (Moebius syndrome)
b. birth trauma (skull fracture, intracranial hemorrhage Etc.)
C. Acquired
    1. Trauma Skull bone disease (osteomyelitis)
    2. Intracranial process (tumor, inflammation, bleeding etc.)
    3. Process in the neck that suppresses the stilomastoideus processus)
    4. Infection elsewhere (otitis media, herpes zoster etc.)
    5. Paralysis syndrome of facial nerve
CLINICAL MANIFESTATION OF
BELL’S PALSY
As BP affects the facial nerve,it causes facial
weakness in a peripheral pattern-that is,
weakness involving the mouth, eye and
forehead. Specific clinical features include :
weakness raising the eyebrow and furrowing
the brow, difficulty or inability to close the eye,
difficulty in gromacing and smiling of the
nasolabial fold.
DIAGNOSIS OF BELL’S PALSY
 Anamnesis or history taking
 Physical examination
 N VII examination
 motoric
 sensoric
 autonomic
DIFFERENTIAL DIAGNOSIS
OF BELL’S PALSY
 Herpes zoster infection of the geniculate ganglion (Ramsay Hunt
syndrome)
 Tholosa hunt syndrome
 Miller Fisher Syndrome
 Cerebellopontine Angle Tumors (CPA)
 Brainstem syndrome
 Acoustic neuroma
 Miastenia gravis
THOLOSA HUNT SYNDROME
 is a rare disorder characterized by severe headache and unilateral with
orbital pain, accompanied by weakness and paralysis (ophthalmoplegia) in
certain eye muscles (extraocular troughs).
 limited to one side of the head, and in most cases affected individuals will
experience sharp and sharp pain and muscle paralysis around the eyes.
 WEBER SYNDROME
 is a syndrome composed of oculomotor paralysis on the same side as the
lesion, resulting in ptosis, strabismus, and loss of light and accommodation
reflexes, as well as spastic hemiplegic on the opposite side of the lesion with
increased reflexes and loss of superficial reflexes.
 Unilateral lesions in mesensefalon lead to hemiparesis or contralateral
hemiparesis Lesions that damage the medial part of the cerebral peduncle
will produce hemiparsis accompanied by an ipsilateral oculomotor nerve
paresis. The combination of both types of paralysis is known by the name
hemiparesis alternans
THERAPY OF BELL’S PALSY
Farmacotherapy
 Oral glucocorticoid, is prednisone 40–60 mg per day for 10 days but if within 10
days there is improvement of patient condition then done tappering off
OR
If there is no Prednison, can also be given oral mineralocorticoids, is
methylprednisolone given at the beginning of a dose of 4x16mg per day.
 can be added antiviral, ie acyclovir 400 mg 5x per day for 7 days or valasiklovir
1g 3x per day for 7 days within 72 hours from onset.
THERAPY OF BELL’S PALSY
 Surgical Therapy
Surgical decompression is recommended as an acute treatment of Bell's
palsy based on neuronal swelling of the temporal bone plays a role in the
trauma of nerve compression.
 Physiotherapy
Physiotherapy, including massage and facial exercises
 Supportive Care
What needs more attention is eye protection. Patients should use artificial
tears and eye ointment. Glasses are important for protecting from light,
wind, and dust. Eyebrows in the form of eye patches at night are often
required
COMPLICATIONS OF BELL’S
PALSY
Some of the most common complications of Bell's palsy are:
 Incomplete sensory regeneration that causes dysgeusia (tasting disorder),
ageusia (loss of tasting), and disestesia (impaired sensation or sensation
unlike normal stimuli).
 Incorrect reinervation of the facial nerve. Incorrect reinervation of the facial
nerve may cause:
- Sinkinesis ie muscles can not be moved one by one or alone.
- Crocodile tear phenomenon, for example, the patient's tears come out when
consuming food.
- Clonic facial spasm (hemifacial spasm), arise "twitch" on the face (facial
muscles move spontaneously and uncontrollably) and also facial muscle spasm,
COMPLICATIONS OF BELL’S
PALSY
Other complications that may occur in people with Bell's Palsy are:
 Damage to the facial nerve that can not be recovered as before.
 Nerve growth that is not in accordance with the supposed to cause
uncontrolled movements on the face.
 Partial or all blindness due to dryness of the eyes that can not close and
the occurrence of damage to the cornea of the dry eye
PROGNOSIS OF BELL’S
PALSY
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CONCLUSION
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