Is Bell palsy and UMN or LMN lesion?
Bell’s Palsy is a lower motor neuron lesion as C7 is involved, Patients with Bell’s palsy have decreased reflexes, decreased tone and are flaccid.
Bell’s Palsy Test:
When patient visits a physiotherapist. Ask him to close eye this is known as bell’s phenomenon. Bell’s palsy patient comes with positive bell’s phenomenon.
Bell’s Palsy Appearance:
- Muscle weakness or paralysis occur.
- Wrinkles on forehead disappear.
- Eyes widen
- Nose wrinkle disappear
- Drooping of mouth
Causes of bell’s Palsy:
What is the main cause of Bell’s palsy?
- Inflammation, swelling or compression of Cranial VII nerve.
- Facial Canal damage
- Reactivation of viral infection i.e herpes simplex, HIV, sarcoidosis.
Bell’s Palsy symptoms:
- Neck stiffness few hours before onset.
- Why is Bell’s palsy so painful? Pain behind ear due to damage of facial canal.
- Mild fever.
Muscles involved in Bell’s Palsy:
Following are the muscles which get affected:
|Frontalis||Elevation of Eyebrows|
|Orbicularis Oculi||Closure of eyelid|
|Orbicularis Oris||Surrounds mouth helps closing mouth|
|Buccinator||Assist Chewing, pull food to center of mouth|
|Mentalis||Dimple formation, Attach lower lip for gripping glass during drinking|
In this condition function of these muscles is affected due to weakness of these muscles. When frontalis is not performing its function normally there is loss of wrinkles on forehead, wrinkles that appear during frowning or anger or while laughing. Due to the weakness of orbicularis oculi eye do not close. Eye muscle contraction is mandatory for closure of eye, as orbicularis oculi is weak closure of eye becomes difficult or impossible. Orbicularis Oris muscle plays its role in closure of mouth or lips. Due to weakness of this muscle mouth do not close completely and drooping of mouth occurs.
Buccinator muscle is involved in chewing and brings food to center of mouth. When it is not functioning properly patient is unable to chew food and food accumulates in the side of mouth and patient throws it out. Due to weakness of platysma muscle clenching becomes difficult. Dimple is formed due to mentalis muscle and it plays its role in gripping the glass while drinking by attaching lower lip to glass. Due to its weakness drinking difficulties occur and dimple disappears.
Patient faces difficulty performing following activities:
- Difficulty in eating and drinking
- Difficulty in smiling
- Reduced speech clarity
- Dryness of eye
Difficulty in eating occurs as buccinators (helps chewing food) are affected. Drinking difficulty occurs due to weakness of mentalis (helps attaching lips to glass). Speech clarity decreases as orbicularis oris is involved. Dryness of eye occur as orbicularis oculi is not functioning properly therefore closing of eye do not occur. In normal condition when we close eye, all dust get washed off, blinking of eye wash off the dust. But as contraction of eye muscles is not occurring, blinking is not possible so dust accumulates over eye surface making it dry.
What is best treatment for bell’s palsy?
Treatment include, Modifying daily activities, doing facial retraining exercises using facial muscles, performing exercises and physiotherapy.
Perform Activities using facial muscles:
What helps Bell’s palsy go away? How do you strengthen your face after Bell’s palsy? how to prevent bell’s palsy?
- Is chewing gum good for Bell’s palsy? Ask the patient to chew gum as it will strengthen buccinators.
- Tissue blowing
- Blow balloon
- Use eye drops
- Wash eye with cold water
- Ask patient to lye after each single hour to distribute blood.
- Is massage good for Bell’s palsy? Do facial massage, it increases lymphatic and blood flow.
- Ask him to hold straw in mouth, then try drinking with straw and after that ask the patient to blow through straw.
- As patient is unable to close eye, to prevent dryness of eye you can do suturing or taping of eye.
Bell’s Palsy Physiotherapy treatment:
What helps Bell’s palsy go away? Physiotherapist might use PNF nerve stimulation, Transcutaneous electrical stimulation, ultrasound and infrared. What kind of physical therapy helps Bell’s palsy?
When a muscle is not working, there is loss of contraction as a result atrophy occurs and at the area of atrophy fibrous tissue formation occurs. Fibrous tissue is inelastic so contractures form there. To prevent this process contractions are needed so TENS is applied to induce muscle contractions and to prevent atrophy and contracture formation. Transcutaneous electrical stimulation produces muscle contraction and establish nerve communication.
Infrared can also be used to treat Bell’s Patient. While using infrared avoid radiations contact with eyes. Close patients eye and place wet cloth over eye to prevent dryness. Reason behind using wet cloth is patient’s eye is already dry if you use dry cloth over eye heat will get absorb in cloth and will make eye more dry. So wet cloth is preferred.
Ultrasound therapy can be done in particular region in front of ear. As it is a damage of facial canal and facial canal is located in middle of the ear. So ultrasound is done in front of ear or on upper cheek area.
Facial retraining Exercises:
Patient is asked to do active exercises, resisted exercises are performed in chronic cases.
- Using fingers pull the skin on the side of nose towards ear.
- With the help of fingers make wrinkles on forehead.
- Pull side of mouth outwards using fingers.
- Using finger pull skin at the side of eye towards ear till it get closed.
- Taping is done in the same positions.
Upper motor neuron facial palsy:
Muscle paralysis occur due to nerve damage. It is an upper motor neuron lesion. Facial nerve nucleus is damaged inside brain.
Causes of Facial Palsy:
- Idiopathic bells palsy
- Facial nerve nucleus in brain gets damaged.
- Viral attack
- C7 nerve damage in brain
Pregnancy, Obesity, Diabetes.
Bell’s Palsy vs. Facial Palsy:
How can you tell the difference between UMN and LMN facial palsy?
Difference between UMN and LMN facial palsy:
Let’s have a look at difference between Bell’s and Facial Palsy. Main difference between bells palsy and facial palsy is Bell’s Palsy is a lower motor neuron lesion while Facial palsy is an upper motor neuron lesion. In lower motor neuron lesion communication of nerve is affected, there is an issue in path of nerve communication. In upper motor neuron lesion nucleus of nerve is damage inside brain.
What is the difference between facial palsy and Bell’s palsy?
|Bell’s Palsy||Facial Palsy|
|Lower motor neuron lesion||Upper motor neuron lesion|
|Cranial VII nerve inflammation||Facial nerve damage in brain|
|Facial canal damage||Facial nerve nucleus in brain damage|
|Eye Partially close||Complete eye drop|
|Inflammation, compression or swelling of Cranial nerve VII.||Meningitis, trauma, haemmhorage, thrombus|
|Less flaccid||More flaccid|
|Less wrinkle loss on forehead||Increased wrinkle loss on forehead|
|positive bell’s phenomenon||Eye closure test|
|Complete recovery in 3 months||Complete recovery in 6 months|