Overview:  In this topic we covered –

  1. Facial Nerve branches
  2. Bell’s Palsy
  3. Bell’s Phenomenon
  4. Lagophthalmos
  5. Exposure Keratopathy
  6. Corneal Ulcers
  7. Epiphora or Watering Eye
  8. Paralytic Ectropion
  9. Treatment

Bell's Palsy by tcml, enmeder

Before studying Bell’s Palsy, you have to know branches of facial nerve and which muscles would it supply.

Facial Nerve: Branches Overview

  1. Greater Petrosal Nerve: Join Deep Petrosal Nerve ( from Sympathetic nerve plexus around Internal Carotid Artery ) and form Nerve of Pterygoid Canal
  2. Br. to Stapedius Muscle ( Muscle present in Middle Ear Cavity and supply by Facial Nerve )
  3. Chorda Tympani Nerve ( CTN ): Carry Taste Sensation ( Special Sensory / Afferent ) from Anterior 2/3 of Tongue
  4. Posterior Auricular Nerve: Supply to Occipitofrontalis Muscle ( Occipital Belly )
  5. Br. to Diagastric Muscle: Supply Posterior Belly of Digastric Muscle
  6. Br. to  Stylohyoid: Supply Stylohyoid Muscle
  7. Terminal Branches: Temporofacial Nerve ( Temporal, Zygomatic branches ) and Cervicofacial Nerve ( Buccal, Marginal Mandibular and Cervical branches ): Supply Facial Muscles

You can easily remember Bell’s Palsy in below 14 Point

[ Point 3 to 12: Denotes Symptoms and Sign of Bell’s Palsy from up to down on the face ] * for detail see the image

  1. Infra nuclear or LMN ( Lower Motor Neuron ) lesion of the facial nerve or 7th Cranial Nerve ( as result facial muscles are paralyzed and facial expressions are lost )
    • [ You will also read it in NeuroAnatomy and ENT: Cranial Nerve and its Disorder ]
  2. The Upper and lower quarter of the face on the same side ( Right upper and lower / Left Upper and lower ) are paralyzed, as result affected parts of the face are motionless ( due to facial muscles palsy )
    • [ You will also read it in Anatomy: Head and Neck: Facial Muscles: SCALP and Around Eye, Nose, Mouth ]
  3.  Forehead wrinkles absent
    • Reason: Occipito frontalis muscle paralysis ( Supply by Temporal and Posterior Auricular branch of the facial nerve )
  4. The patient is unable to close his eye
    • Reason: due to paralysis of Orbicularis oculi muscle
      1. When the patient closes his eye forcefully: Eyeball turn up and out Called: Bell’s Phenomenon
        • [ You will also read it in Ophthalmology: Eyelid ]
      2. Lagophthalmos: the patient is unable to close eyelid completely
        • [ You will also read it in Ophthalmology: Eyelid ]
      3. Exposure Keratopathy: Due to corneal surface of eyeball not fully covered by Eyelid ( as result corneal surface damage )
        • [ You will also read it in Ophthalmology: Cornea ]
      4. Drying of Cornea: lead to Corneal Ulcers
        • Reason: Corneal surface of eyeball not fully covered by Eyelid as a result Cornea remains intact with the environment for a long time cornea dry
        • + Use Lubricating Eye drops / Artificial Tear: It keeps the corneal surface wet. ( See point 14. )
        • [ You will also read it in Ophthalmology: Cornea ]
  5. Tear overflow on the cheek: Called Epiphora / Watering Eye
    • Reason: due to Paralytic Ectropion ( Out rolling of the eyelid margin ) tear drainage decreases and tear flow on the cheek
    • [ You will also read it in Ophthalmology: Eye Lid ]
  6. Hyperacusis
    • Reason: due to paralysis of stapedius muscle ( Supply by Facial Nerve )
  7.  Nasolabial fold absent ( present between nose and mouth )
  8. Sagging of angle of mouth
  9. Drooping of Saliva from the angle of the mouth ( due to palsy of Orbicularis Oris Muscle )
    • Reason: due to paralysis of Orbicularis Oris Muscle ( for more detail read 10. point )
  10. Articulation of labial is impaired: as a result air leak between two lips
    • Reason: due to paralysis of Orbicularis Oris Muscle ( Supply by Facial Nerve )
  11. During Mastication food accumulate between teeth and cheek ( Vestibule )
  12. Taste sensation loss from Anterior 2/3 of tongue
    • Reason: because taste sensation from Anterior 2/3 of the tongue are carried out by Chorda Tympani Nerve ( branch of the facial nerve )
  13. Paralyzed upper and lower quarter of face pulled towards health side: Facial Asymmetry
    • Reason: Paralysed side of the face is pulled by the muscle of the health side of the face.
  14. Treatment :

  • Lubricating eye drops or Artificial tears: It keeps the corneal surface wet. ( see point 4. )
  • Steroids: Prednisone ( decrease inflammation and oedema)
  • Steroids: Prednisone ( decrease inflammation and oedema)

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