(BQ) Part 2 book “Dental management of medically complex patients” has contents: Management of patients with facial paralysis, dental management of patients with gastrointestinal diseases, dental management of patients with alcohol abuse and liver cirrhosis, dental management in pregnancy, and other contents. | Management of Patients with Facial Paralysis 10 63 SR Prabhu Management of Patients with Facial Paralysis LEARNING OBJECTIVES After studying this chapter the student should be able to: 1. Provide a classification of facial paralysis. 2. Know how to take history from a patient with facial paralysis. 3. Know how to examine a patient with facial paralysis. 4. Know the key clinical features of Bell’s palsy. 5. Know what investigations are generally carried out in patients with Bell’s palsy. 6. Know the treatment modalities available for Bell’s palsy. 7. Know the prognosis of treatment for Bell’s palsy. INTRODUCTION Damage to the seventh cranial nerve (facial nerve) which controles the muscles of facial expression results in facial paralysis. The neurological level of the damage determines the clinical picture. It is important to remember that facial paralysis is a symptom, not a disease. Facial paralysis may be idiopathic as in Bell’s palsy, or may be a part of an underlying disease process, traumatic event or congenital syndrome. 64 Dental Management of Medically Complex Patients CLASSIFICATION Facial paralysis is classified on the following basis: 1. Degree of paralysis • Partial • Complete. 2. Nature of onset • Delayed • Immediate 3. Aetiology • Idiopathic (Bell’s palsy) • Blunt trauma (surgical, temporal bone fracture) • Herpes-zoster infection • Tumour invasion (parotid tumours) • Infection of the facial nerve (CN VII) • Mastoiditis and otitis media • Birth trauma: Congenital/birth trauma at delivery • Brain lesions: Supranuclear or brainstem lesions • Other: Sarcoidosis, polyneuritis, leprosy, etc. The commonly followed classification is the one based on aetiology. HISTORY TAKING A detailed history will reveal the likely cause of the facial paralysis. History should include: • The nature of the onset of facial palsy (delayed or immediate) • The timing of facial paralysis • Associated otologic findings such as hearing loss, tinnitus, vertigo, itching .
