Bell's Palsy
DH 24 - Mrs. Kunz
DEMOGRAPHICS: Mrs. Nguyen, 70 years old, female, Asian
PHYSICAL ASSESSMENT: Facial paralysis of one side of the face that leads to difficulty in closing the eye on that side, drooling due to can’t control the face muscles on that side which leads to eat & drink difficulty, loss of sense of taste, dry eye or mouth, facial expression changing, headache, sensitivity to sound, pain behind or in front of the ear, twitching & weakness in face.
MENTAL ASSESSMENT: Self-conscious, disbelief, embarrassment, helplessness, anger & frustration
SOCIAL ASSESSMENT: Retreats…due to decrease in self-image
MEDICAL ASSESSMENT: History of having chicken pox in childhood, has had stressful life, on high blood pressure medication.
DENTAL HISTORY: History of periodontal disease that has been well maintained
COMMUNICATION:
* The most common side of facial paralysis is the right side of the face.
* It will take about 2 weeks or more to recover. Most patients recover without any cosmetically obvious deformities. Sometimes incomplete motor
regeneration or sensory recovery.
* Medications: Usually no treatment is needed, only relief from symptoms.
Antiviral agents, Corticosteroids, lubricating eye drops or ointment to protect eye, eye patch for sleeping/protective eyewear during
the day.
APPOINTMENT PLANNING: Frequent appointments to maintain oral health.
CLIENT POSITIONING: Upright position to avoid choking and aspiration of foreign substances with clients who have difficulty swallowing.
DH PROCEDURES: Can use mouth prop, optimal water suctioning.
SAFETY PRECAUTIONS: Safety goggles important.
OHI: May have increased food retention due to lack of feeling and impaired natural cleansing mechanism. Xerostomia can lead to caries. Use fluoride and
saliva substitude.
PERSONAL REFLECTION: My mom had Bell’s palsy a few years ago. She was so scared and disbelieved it when looked at her face in the mirror. She was crying, frustrated, and didn’t understand why. Even though she has some small issues with her health she has been taking good care of herself. At that time, I did not know what it was that about when I saw my mom going through that problem. She said she had Shingles according to the doctors’ diagnosis. I went home and did some research on the Internet. I found out that the symptoms that my mom had did not fit in with what I found for Shingles. A few months later, I had a chance to learn about Bell’s palsy in an anatomy class. I was sure my mom had had Bell’s palsy. I confirmed with my mom about it but she still does not believe me. I think she must have misunderstood what the doctors said. However, it took 2 weeks for her to recover completely back to normal. My mom was happy about it. So was I and we hope it will not come back.
ADDITIONAL INFORMATION:
Darby and Walsh book on chapter 46
New England Journal of Medicine - Early Treatment with Prednisolone or Acyclovir in Bell's Palsy
PHYSICAL ASSESSMENT: Facial paralysis of one side of the face that leads to difficulty in closing the eye on that side, drooling due to can’t control the face muscles on that side which leads to eat & drink difficulty, loss of sense of taste, dry eye or mouth, facial expression changing, headache, sensitivity to sound, pain behind or in front of the ear, twitching & weakness in face.
MENTAL ASSESSMENT: Self-conscious, disbelief, embarrassment, helplessness, anger & frustration
SOCIAL ASSESSMENT: Retreats…due to decrease in self-image
MEDICAL ASSESSMENT: History of having chicken pox in childhood, has had stressful life, on high blood pressure medication.
DENTAL HISTORY: History of periodontal disease that has been well maintained
COMMUNICATION:
* The most common side of facial paralysis is the right side of the face.
* It will take about 2 weeks or more to recover. Most patients recover without any cosmetically obvious deformities. Sometimes incomplete motor
regeneration or sensory recovery.
* Medications: Usually no treatment is needed, only relief from symptoms.
Antiviral agents, Corticosteroids, lubricating eye drops or ointment to protect eye, eye patch for sleeping/protective eyewear during
the day.
APPOINTMENT PLANNING: Frequent appointments to maintain oral health.
CLIENT POSITIONING: Upright position to avoid choking and aspiration of foreign substances with clients who have difficulty swallowing.
DH PROCEDURES: Can use mouth prop, optimal water suctioning.
SAFETY PRECAUTIONS: Safety goggles important.
OHI: May have increased food retention due to lack of feeling and impaired natural cleansing mechanism. Xerostomia can lead to caries. Use fluoride and
saliva substitude.
PERSONAL REFLECTION: My mom had Bell’s palsy a few years ago. She was so scared and disbelieved it when looked at her face in the mirror. She was crying, frustrated, and didn’t understand why. Even though she has some small issues with her health she has been taking good care of herself. At that time, I did not know what it was that about when I saw my mom going through that problem. She said she had Shingles according to the doctors’ diagnosis. I went home and did some research on the Internet. I found out that the symptoms that my mom had did not fit in with what I found for Shingles. A few months later, I had a chance to learn about Bell’s palsy in an anatomy class. I was sure my mom had had Bell’s palsy. I confirmed with my mom about it but she still does not believe me. I think she must have misunderstood what the doctors said. However, it took 2 weeks for her to recover completely back to normal. My mom was happy about it. So was I and we hope it will not come back.
ADDITIONAL INFORMATION:
Darby and Walsh book on chapter 46
New England Journal of Medicine - Early Treatment with Prednisolone or Acyclovir in Bell's Palsy