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Bell's Palsy
- Lesion of CN 7 (facial)
- Flaccid paralysis of the MMs of facial expression (usually) on the same side as the (brain) lesion
- Bilateral if lesion in barin, Unilateral if it's a NN lesion
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Causes of Bell's Palsy
- Compression from edema (pregs, mid ear infection, diabetes, hypertension, hypothyroid)
- Conditions effecting parotid (mumps, cancer, chaw)
- Compression from inflamation (trauma)
- Exposure to chill
- Genetics
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Bell's Palsy S&S
(10)
- Unilateral flaccid paralisis of facial MMs
- Incomplete eye closure => eye patch
- Loss of blink reflex => tearing
- Can't whistle
- Difficulty articulation sounds
- Dribbly-drinking
- Increase/Decrease of salivation or lacrimation
- Loss of or altered sense of taste
- Heightened sensitivity to low tones
- Pain
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The Branches of CN 7
(6)
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
- Post Auricular
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The CN 7 branches supply:
(6)
- Temporal: Orbital MMs, but not Lev Palp Sup
- Zygomatic: Zygoma, Orbital and Intraorbital area
- Buccal: Buccinator MM and Upper Lip
- Mandibular: Lower lip and Chin MMs
- Cervical: Platysma, Stylohyoid, Post digastric MMs
- Post Auricular: Occipitalis MM
- Also, another division:
- Ant 2/3 of tongue
- salivary glands
- lacrimal glands
- Soft palate
- external auditory meatus
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Pathway of CN 7
Brainstem => Exteranl Surface (usually) of the cranium => Emegerges thru stylo-mastoid foramen => thru parotid gland => crosses external carotid AA, divides behind ramus of lower jaw (temporo-facial and cervico-facial) => further divide into six branches
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Special Tests for Bell's Palsy
(3)
- 1. Chvostek's Sign: "Clench Jaw" => palp masseter, move ant => "relax" => tap the NN
- + is wincing
- 2. Facial MM expression testing: Make faces
- + if there is MM paralysis
- 3. Sensory testing: "Close eyes" => test skin sensation w/ kleenex
- + if no sensation is reported
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Tx goals for Bell's Palsy
- D. Breathing
- Dec. SNS firing, Edema, Pain
- Tx comps (HT + TrP of neck MMs etc)
- Maintain Tissue health
- Prevent contracture
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