Case Report on Postpartum Bell's Palsy: Successful Recovery with Integrated Unani, Steroid and Physiotherapy Regimen.

Background: Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances.Aim of Study: To investigate the role of non affected side relaxation on function outcome in patient with Bell's Palsy (BP).Patients and Methods: Thirty patients with unilateral BP were assigned into two equal groups (Group A & Group B): Group (A) received conventional physical therapy program (laser therapy, faradic stimulation, therapeutic facial massage and facial exercise) on the affected side only while Group (B) received a designed relaxation program (Transcutaneous Electrical Nerve Stimulation (TENS), therapeutic facial massage, intraoral massage and ice massage) on the non affected side plus conventional physical therapy program on the affected side. Sunnybrook Facial Grading System (SFGS) and Electroneuronography (ENoG) were used to assess the severity of facial nerve degeneration. Assessment using both SFGS and EnoG was done pre-treatment, post one month of treatment and post two month of treatment.Results: The study has revealed that the function outcome has improved significantly in each group with no significant difference between both groups.Conclusion: It can be concluded that a designed relaxation program of the non-affected side has no significant effect on the function outcome in patient with Bell's palsy.

Introduction and Aim: Bell’s palsy is an instantaneous lower motor neurons injury of 7th cranial nerve associated with infection and swelling. It produces unexpected unilateral weakness of facial muscles, progresses rapidly and attains peak symptoms within a week. The most common age of incidence is between 20 to 40 years. Although facial paralysis in Bell’s palsy is self-limited, only 80% of the patients make a full recovery. There are studies stating that both galvanic electrical stimulation and laser therapy speed up the recovery of facial paralysis, but the extent of complete recovery is unknown. Hence, this study is an attempt to understand and compare how laser therapy and galvanic electrical stimulation affect facial appearance and facial muscle functions in Bell's palsy. Materials and Methods: This study included thirty subjects with acute onset of Bell’s palsy aged between 20-40 years. They were randomly grouped into A and B. Galvanic electrical stimulation and low-level laser therapy were given to group A and group B respectively for 6 weeks (3 sessions/week) along with facial exercises. Facial disability index scale was used to measure facial muscle function and Sunny brook scale was used to measure facial symmetry in pre- and post-treatment periods. Results: When comparing the pre- and post-mean values of groups A and B on the Sunny Brook facial grading and the facial disability index (physical, social), group B (with low level laser therapy) showed a highly significant difference in mean values at p 0.001. Conclusion: Low-level laser therapy can be used as an adjective in treating the patients with Bell’s palsy.

Article1 August 1942THE OCCURRENCE OF PERIPHERAL FACIAL PARALYSIS IN HYPERTENSIVE VASCULAR DISEASEHAROLD R. MERWARTH, M.D., F.A.C.P.HAROLD R. MERWARTH, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-17-2-298 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough paralysis of the peripheral portion of the facial nerve is a very common disorder, its occurrence as a result of localized compressive bleeding in hypertensive vascular disease has been regarded as rare. Whereas hemorrhage into the facial aqueduct as a cause of facial palsy was recognized by earlier observers, their pathological findings and opinions have been ignored recently in the tabulated causal classifications of facial paralysis.Since 1925, 468 cases of facial paralysis peripheral in location have been observed. Eighteen of this number were myoclonic facial palsies. Although the ultimate picture of myoclonic paralysis resembles that of the contractured...Bibliography1. MOXON : Transactions of the Pathologic Society of London, 1869, xx, 420. Google Scholar2. GOWERS WR: Diseases of the nervous system (Am. Edition), 1888, Blakiston & Son, Philadelphia, p. 648. Google Scholar3. OPPENHEIM H: Textbook of nervous diseases, 1910, Darien Press, Edinburgh, i, p. 482. Google Scholar4. KEITHWAGENERKERNOHAN NHPJW: The syndrome of malignant hypertension, Arch. Int. Med., 1928, xli, 141. CrossrefGoogle Scholar5. AMBERG S: Hypertension in the young, Am. Jr. Dis. Child., 1929, xxxvii, 335. Google Scholar6. MAY E: Néphrite chronique et paralysie faciale, Bull. et mém. Soc. méd. d. hôp. de Paris, 1930, liv, 915-917. Google Scholar7. MONIER-VINARDPUECH P: Néphrite chronique et paralysie faciale, Bull. et mém. Soc. méd. d. hôp. de Paris, 1930, liv, 977-980. Google Scholar8. GRIFFITH JQ: Involvement of the facial nerve in malignant hypertension, Arch. Neurol. and Psychiat., 1923, xxix, 1194. Google Scholar9. GALLAVARDIN ML: Hypertension artérielle et paralysie faciale périphérique, Médecine, 1936, xvii, 186-190. Google Scholar10. MERWARTH HR: The recurrence of facial paralysis, Am. Jr. Med. Sci., 1935, clxxxix, 2, 270. CrossrefGoogle Scholar11. POLITZER A: Diseases of the ears, 1926, Lea and Febiger, Philadelphia, p. 37. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: HAROLD R. MERWARTH, M.D., F.A.C.P.Affiliations: Brooklyn, New York*Read before the Brooklyn Neurological Society January 28, 1941. Received for publication August 8, 1941. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Use of Phototherapy for Bell’s PalsyBell's palsy: an overviewAnatomical consideration of the temporal bone as a pathogenesis of Bell’s palsyPeripheral facial palsy after varicella. Report of two cases and review of the literatureCorrelates of degree of nerve involvement in early Bell's palsyBell's PalsyIdiopathic facial (Bell's) palsy: a clinical survey of prognostic factorsBell's palsy: factors affecting the prognosis in 200 patients with reference to hypertension and diabetes mellitus‘Bell's palsy’ in accelerated hypertensionIdiopathic Facial Paralysis, Pregnancy, and the Menstrual CycleIdiopathic Facial Palsy and PregnancyMelkersson-Rosenthal syndromeTransitory unilateral facial parallysis (Bell's palsy)Tratamiento de la parálisis facialXCVI The Otological Concept of Bell's Palsy and its TreatmentSymposium: The Treatment of Facial ParalysisLXIV The Present Position of Facial Nerve Surgery 1 August 1942Volume 17, Issue 2 Page: 298-307 Keywords Facial nerve Hemorrhage Paralysis Vascular diseases ePublished: 1 December 2008 Issue Published: 1 August 1942 PDF downloadLoading ...

Contrast-enhanced MR images (at 1.5 T) were obtained in 11 patients with facial palsy. The group included five people with acute idiopathic facial (Bell's) palsy, three with chronic idiopathic facial palsy, and one each with acute facial palsy after local radiation therapy, acute facial palsy resulting from herpes zoster virus infection, and facial palsy caused by facial neuroma. Eight of the 11 patients demonstrated marked enhancement of the affected facial nerve from the labyrinthine portion through the descending canal. Three patients also demonstrated mild enhancement of the distal canalicular portion of the facial nerve, simulating small distal acoustic neuromas. No difference in the pattern of enhancement between the acute or chronic Bell's palsy patients was seen. Radiographic resolution appeared to lag behind clinical resolution. The facial neuroma appeared distinct from the other lesions as a focally enhancing mass. The enhancement pattern in the Bell's group correlated with the histopathologic features of Bell's palsy and is consistent with the viral hypothesis of the syndrome. Thin-section contrast-enhanced MR scans are recommended for individuals with atypical presentation of facial paralysis. In the proper clinical setting, contrast-enhanced MR imaging may permit a positive radiographic diagnosis of Bell's palsy, which has previously been a diagnosis of exclusion.

Key words: Bell's palsy, brainstem glioma, magnetic reso- nance imaging Introduction Facial palsy of the peripheral type is generally seen in the pain clinic and is often treated with a stellate gang- lion block. The most common cause of peripheral facial nerve palsy is Bell's palsy, although its etiology remains controversial. The diagnosis of Bell's palsy is usually made by exclusion of other conditions such as herpes zoster oticus (Ramsay Hunt syndrome), trauma (including skull base fracture and surgery), otitis media, and neoplasm [1]. Isolated peripheral facial nerve palsy of neoplastic origin is uncommon. We herein describe a case of peripheral facial nerve palsy which was initially diag- nosed as Bell's palsy but was later found to be caused by an intrinsic brain stem tumor. Case report A 9-year-old boy presented to the Pediatric Depart- ment of our University Hospital in August 1990 with left facial weakness. His mother noticed the hyperemic conjunctiva and lacrimation of his left eye at the end of June. Consultation with the ophthalmologist revealed no abnormality in his left eye and the hyperemia im- proved with conservative therapy. In July, facial asym- metry became obvious. He was diagnosed as having Bell's palsy by a pediatrician in August and was referred to. our pain clinic. Address correspondence to: K. Kodama Received for publication on May 31, 1993; accepted on January 6, 1994 Upon examination, the patient had a left facial nerve palsy of the peripheral type (score of the facial paresis was 24/40), however, no other neurological deficits were seen. An audiogram failed to reveal a hearing abnormality. Although repeated stellate ganglion block was given, his facial palsy progressed slowly over a 2- month period, suggesting an etiology other than Bell's palsy. Magnetic resonance imaging (MRI) in September demonstrated a tumor in the left pons and brachium pontis extending into the left cerebellopontine angle (Fig. 1). The lesion was seen as a hypointense and hyperintense area on T1- and T2-weighted images, re- spectively. He was admitted to the Neurosurgical De- partment on September 29. The positive neurological findings on admission were Bruns' nystagmus, absence of left corneal reflex, decreased gag reflex, and mild trunkal ataxia, in addition to left facial nerve palsy. He underwent a wide suboccipital decompressive craniec- tomy, and biopsy of the tumor indicated low-grade glioma. In spite of postoperative radiation (60 Gy) and chemotherapy including Ranimustine and tumor necro- sis factor, he died due to tumor progression 17 months from the time of his initial symptom. Discussion Eighty percent of peripheral facial nerve palsy cases represent idiopathic or Bell's palsy, of which approxi- mately 20% can be demonstrated to have a specific etiology [2]. Peripheral facial nerve palsy with neoplas- tic origin is uncommon, and is estimated to be the cause in approximately 5% of all cases [3]. The diagnosis of Bell's palsy is unjustified unless an accurate history is taken along with a careful examina- tion of the ear and central nervous system (CNS). The differential diagnosis of neoplastic facial palsy is vast

Idiopathic facial paralysis or Bell's palsy (BP) is type of facial weakness (paralysis); it fairly common disorder predominantly adult age group prevalent, affects facial nerves and muscles; resulting paralysis or dropping of one side of the face. Diode or low-level laser therapy (LLLT) may have helped reduce the inflammation of the facial nerve early intervention with LLLT and appeared to improve facial paralysis no reported adverse effects. One-hundred and twenty (120) subjects were participated in this study; they were divided into three classes; Class one/Forty (40) Bell's palsy patients were treated by low level laser therapy (LLLT). Class two/Forty (40) Bell's palsy patients were treated by transcutaneous electrical nerve stimulation (TENS). Class three/forty (40) healthy control subjects (volunteers) with no signs and symptoms of any systemic diseases, with matching ages and genders with BP patients, those patients diagnosed based on House-Brachmann Scale (HBS). A highly significant difference was observed between LLLT group patients and TENS group patients regarding Bell's palsy classification after treatment (p<0.001), healing (recovery) proportion was significantly higher among LLLT group patients (75%) after treatment.

The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at the 3-mo follow-up in patients with Bell palsy. Further research focused on determining the most effective dosage and length of intervention with electrical stimulation is warranted.

The objective of this study is to investigate the effect of scanning and point application of multiwave locked system (MLS) laser therapy on the recovery of patients with idiopathic Bell's palsy (IBP). A randomized double-blind placebo-controlled trial was carried out on 60 patients with subacute BP. Patients were randomly assigned into three groups of 20 patients each. Facial massage and facial exercises were applied to all patients. Group one received MLS laser as a manual scanning technique (10J/cm2, area 50cm2, total energy 500J). Group two received MLS laser using point application technique (10J/point, 8 points, total 80J). Group three received placebo laser. House-Brackmann scale (HBS) and facial disability index (FDI) were used to evaluate the facial recovery. Assessment was performed at baseline and after 3 and 6weeks of treatment. Comparison within and between groups was performed statistically with significance level p < 0.05. Results showed significant improvement in the FDI and HBS after treatment in all groups. Both scanning and point application significantly improved the score of FDI and HBS more than placebo group. Scanning technique combined with facial massage and exercises had a more significant effect than the point application group or the placebo group in improving FDI and HBS scores after 3 and 6weeks of treatment. The MLS laser is an effective physiotherapy method used for the treatment of patients with IBP. MLS laser in scanning or point application techniques was more effective than exercise alone with greater effect of scanning technique than point application technique.

Bell's palsy is an idiopathic, unilateral facial paralysis, caused by a malfunction anywhere along the facial nerve's peripheral portion, from the pons distally. Bell's palsy is treated by removing the cause of nerve injury, strengthening the face muscles, and restoring facial function. Physical therapy in the form of neuromuscular electrical stimulation (NMES), massage and facial exercises is used as adjuvant to hasten recovery. The aim of this study is to access of role of neuromuscular electrical stimulation (NMES) treatment in Bell’s palsy patients. A detailed neurological assessment of three patients was done with emphasis on facial muscles and severity of paralysis was graded according to House Brackmann scale (HBS). Conventional physiotherapy was given in the form of electrical stimulation, facial massage, exercises and functional re-education on a daily basis. Patients were assessed at weekly and 1months after the treatment. They experienced complete recovery within 1month follow-up, no recurrence was observed and all patients have normal facial movement. Physiotherapy in the form of NMES and facial exercises has a effective role in the early management of Bell’s palsy. Keywords: Bell’s palsy; neuromuscular electrical stimulation; House Brackmann scale; physiotherapy.

To evaluate the incidence of recurrent facial palsy and the frequency of misdiagnosis as Bell's palsy in patients with intratemporal facial nerve schwannomas (FNSs)Methods:A systematic review of PubMed and Cochrane databases and a single-institutional analysis were conducted, covering studies from the past 10 years on adult cases of intratemporal FNS with documented facial nerve function at presentation. Inclusion criteria focused on patients presenting with facial paralysis to assess recurrence rates and misdiagnoses as Bell's palsy. Key outcomes included incidence, severity, and the number of prior facial paralysis episodes at the time of FNS diagnosis. From 284 studies identified, 77 full texts were reviewed, and 53 met inclusion criteria, totaling 531 patients. Among the 531 patients, 55.6% (295) initially presented with facial paralysis. We found that 4.5% (24) of all patients in the systematic review and 22.2% (2) of cases in our institutional review with an intratemporal FNS were initially misdiagnosed with Bell's palsy. Of those who presented with facial paralysis, misdiagnosis as Bell's palsy was noted in 8.14% (24) of the systematic review and 100% (2) of our institutional review. The average House-Brackmann (HB) scores worsened from initial presentation to pre-operative assessment (mean scores: 2.07 ± 1.49 vs 2.94 ± 1.73). Our single-institutional and systematic review emphasizes that facial paralysis is a common presenting symptom of FNS. Although idiopathic (Bell's) palsy is the most frequent cause of facial paralysis, it remains a diagnosis of exclusion and a neoplastic cause should be ruled out in certain cases. A high index of suspicion is warranted for persistent (>3 months) or recurrent facial palsy, particularly when accompanied by otologic symptoms. Early identification of FNS enables timely interventions, such as facial nerve decompression, which may preserve native nerve function.

The effectiveness of low-level laser therapy combined with facial expression exercises in patients with moderate-to-severe Bell's palsy: A study protocol for a randomised controlled trial

Background: Bell's palsy is the most common cause of lower motor neuron type facial nerve palsy and one of the most frequently encountered presentations in Department of Neurology. Initial treatment involves oral corticosteroids, possible antiviral drugs, protection of the eye from desiccation and physiotherapy. But in case of patients with Bell's palsy and diabetes mellitus (DM) decision of prescribing steroid is a major concern due to risk of hyperglycaemia and still a point of conflict. Aim of this study is to observe the outcome of diabetic patients with Bell's palsy with and without steroid therapy. Methods: This retrospective study was conducted from January 2017 to December 2020, in Department of Neurology of BIRDEM General Hospital, Shahbag, Dhaka, Bangladesh. During this period 50 adult diabetic patients with Bell's palsy were recruited retrospectively from hospital records according to inclusion criteria and divided into two groups depending upon the duration of symptoms and prescribing steroid. Group I consisted of patients with Bell's palsy who attended after 72 hours of onset of symptoms and was not prescribed steroid or antiviral drugs, whereas Group II included patients attending within 72 hours of onset of symptoms and received steroid and antiviral drugs. House-Brackmann (H-B) Grading system was used to assess the severity of facial dysfunction. Patients of Grade III and above were recruited in this study and during follow up Grade I and II were considered as recovered. All participants of Group II received prednisolone in divided doses of up to 60 mg for 5 days and then tapered over next 5 days along with the antiviral agents. Patients in the Group I were given supportive care. All patients of both the groups received physiotherapy for facial asymmetry and medication for eye care along with close monitoring and management of diabetes and other comorbidities. H-B Grades at onset, after 10 days, at the end of 1st and at 3rd month after facial paralysis were assessed. Recovery time and the number of patients who demonstrated improvement were compared between the groups. Results: Total 50 adult diabetic patients with Bell's palsy were included. Mean age at presentation was 48.5 ± 13.6 years, 44% were male and 56% female. Hypertension (HTN) was present in 50% cases. A total of 30 patients (60%) received oral steroid with anti-viral drugs and 20 (40%) received only supportive treatment. Significant statistical difference was observed with regard to H-B Grades, recovery time and number of patients between steroid group (Group II) in comparison to patients of non-steroid group (Group I) after 10 days (p 0.007), at 1st month ( p &lt;0.001) and at 3rd months (p &lt;0.001) after facial paralysis. Among comorbidities HTN (p 0.021), Glycated haemoglobin (HbA1c) (p 0.033) and High density lipoprotein (HDL) (p 0.005) contributed to the outcome. Conclusion: From the present study it is observed that patients with DM with Bell's palsy, the recovery of facial functions may be satisfactory with steroid therapy. Bangladesh Crit Care J March 2022; 10 (1): 33-37

Objectives: We intend to find out current practice patterns in managing Bell’s palsy among the physiotherapists of Sargodha, Pakistan. Methods: A cross-sectional study was conducted from May to August 2022. Data were obtained from 50 physiotherapists working in various clinical settings of Sargodha with more than 2 years of clinical experience. They were selected using convenient sampling. A self-designed questionnaire was used to gather all necessary information regarding the physical therapy practice patterns of Bell’s palsy. The obtained data were analyzed by using SPSS software, version 20. Results: Proprioceptive neuromuscular facilitation (PNF) was the preferred (42%) neurodevelopmental technique used in current practice patterns to manage Bell’s palsy. The most used therapeutic exercises by the physiotherapists were facial expression coordination exercises (66%). Also, 44% of physiotherapists used electrical muscle stimulation as the preferred electrotherapeutic modality in their current practice. Soft tissue release (54%) was the most preferred manual therapy technique in Bell’s palsy patients. The combination of electrical muscle stimulation, facial exercises, and biofeedback was the most used (54%) among physiotherapists. Discussion: Current practice for Bell’s palsy treatment includes PNF techniques, facial expression coordination exercises, soft tissue release, and electrical muscle stimulation by most physiotherapists in Sargodha. The most preferred combination was facial exercises, electrical stimulation, and biofeedback.

Background: Bell’s palsy is one of the most common problems that affect motor neurons of facial muscles either unilateral or bilateral. It affects the function and quality of life frequently. Therefore, physiotherapists focus on restoring the facial function with different modalities. Electrical stimulation is one of these modalities included in the physiotherapy program to enhance recovery of Bell’s palsy. Purpose: The aim of this study was to examine the effect of transcutaneous electrical nerve stimulation and faradic current stimulation on the recovery of Bell’s palsy. Methods: One hundred and ninety-six patients from both genders with unilateral Bell’s palsy; their ages ranged from 15 to 60 years. They were divided randomly into four groups with forty-nine patients in each group. Group A received conventional therapy, group B received transcutaneous electrical nerve stimulation (TENS), group C received faradic current stimulation, and group D received TENS + faradic current. All patients were assessed at the initial treatment (after 2 weeks of onset), after one month, and at the end of the study by using the House Brackmann Scale (HBS) for the severity of symptoms and facial symmetry which consist of six grades from normal to total paralysis. Results: In group B, there was a statistically significant improvement in grade IV, V, and VI compared to groups A, C, and D while there was no statistically significant difference among the four groups on grade II and III. Conclusion: TENS is more effective in treating moderately severe dysfunctions as well as total paralysis than convention therapy, faradic current and TENS plus faradic current in patients with acute Bell’s palsy.

Bell's palsy is the most common cause of peripheral facial nerve paralysis. Although herpes simplex virus type 1 (HSV-1) infection has been strongly suggested as a cause of Bell's palsy, the pathomechanism of the facial nerve paralysis is unclear. Previously, we had succeeded in producing an animal model of acute, transient and homolateral facial paralysis by inoculating HSV-1 into the auricle, simulating Bell's palsy. To clarify the mechanism of this facial nerve paralysis, electrophysiological testing of the trigemino-facial reflex (blink reflex) and electroneuronography (ENoG) were carried out, and a histopathological study of the facial nerve was subsequently performed. The blink reflex and ENoG were examined twice ; during facial paralysis on day 10 and after recovery on day 17. The R1 latency of the blink reflex was prolonged or disappeared on the paralyzed side during facial paralysis, but recovered in all animals with the corresponding recovery of facial nerve paralysis. ENoG values were inconsistent during facial nerve paralysis and did not normalize even after complete recovery of the facial nerve paralysis. The histopathological studies demonstrated that mixed nerve damage, demyelination and axonotomesis, were present, although demyelination was dominant. Collectively, the electrophysiological and histopathological findings suggested that the pathomechanism of facial nerve paralysis caused by HSV-1 infection is mainly due to demyelination of the nerve, which was represented as a conduction block in electrophysiological testing. The present study suggested that the facial nerve damage underlying Bell's palsy involves mixed nerve damage including demyelination and axonotomesis, and the prognosis of facial nerve paralysis is dependent on the balance of these two kinds of nerve damage.