Texas EMS Magazine, Volume 33, Number 6, November/December 2012 Page: 28
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uga Bell's palsy:
Continuing Education A common cause of facial paralysis
By Jolene E. Cormier; EMT-P CHTObjectives
At the end of the CE
module, the EMS
provider will be able to:
1. Define Bell's palsy.
2. Be able to recognize
and discuss the
signs and symptoms
associated with
Bell's palsy.
3. Differentiate
between the signs
and symptoms
associated with a
cerebrovascular
accident and those
associated with
Bell's palsy.
4. Discuss the
prehospital
interventions the
EMT may expect
to preform that
would help treat and
comfort a patient
with Bell's palsy.Facial nerve: the facial nerve's nuclei are in the
brainstem. Orange: nerves coming from the left
hemisphere of the brain. Yellow: nerves coming from
the right hemisphere of the brain. Creative credits;
Patrick J. Lynch, medical illustrator;
C. Carl Jaffe, MD, cardiologist.
Introduction
Idiopathic facial paralysis, commonly
known by the term Bell's palsy, is the most
common cause of facial paralysis, affecting
approximately 40,000 Americans annually
according to the National Institute of
Neurological Disorders and Strokes.' The
condition is named for the Scottish surgeon
who first described it in the 1800s, Sir Charles
Bell." Bell's palsy can occur suddenly and
produces stroke-like symptoms by causing
unilateral or bilateral facial paralysis. The acute
onset of facial paralysis, and its resemblance
to stroke, is likely to cause high anxiety
among people who develop the disorder. This
may precipitate a call to EMS for medical
assistance. There are many differences between
Bell's palsy and a stroke; a basic knowledge of
the disease process and how it affects the face
will help paramedics recognize this condition
and differentiate between the two neurological
disorders.Etiology
The VII cranial nerve (really a pair of
nerves) is a facial nerve that originates in the
brain stem between the pons and the medulla.
This cranial nerve has both sensory and motor
functions, but it is primarily a motor nerve
responsible for controlling the muscles in the
face. The right side of the face is controlled by
one of the paired nerves and the left side by
the other. Inflammation or trauma to the facial
nerve appears to be the cause of the paralysis
seen in Bell's palsy. It is very unlikely that
both nerves will be affected-63 percent of
the time the paralysis is seen only in the right
side.'
The definitive cause of Bell's palsy
remains unknown but ongoing research
continues to provide clues. Many specialists
believe a virus is to blame; often patients have
reported having a viral infection prior to the
onset of symptoms. Viruses possibly linked
to the disorder include syphilis, herpes zoster,
Lyme disease, HIV, Epstein-Barr, influenza
and even the common cold." Some studies
point to a correlation between Bell's palsy and
the herpes simplex virus type 1 (HSV-l) which
has been found postmortem in a collection
of cranial nerve fibers called the geniculate
ganglion.', Another hypothesis points to
edema and ischemia caused by compression
of the facial nerve as the causative factor. The
facial nerve travels through the temporal bone
via a small canal called the facial or fallopian
canal (known by both terms); compression
of this nerve within that bony canal has been
identified with the aid of MRI scans in patients
suffering from Bell's palsy.-
Although the cause of the neurological
disorder is unknown, research and tracking
data do show certain populations to be at a
higher risk of developing the disorder than
others. These include women who are pregnant
(who are over three times more likely to
develop the disorder), diabetics and people
older than 65 years of age. Besides a greater
propensity for developing the neurological28 Texas EMS Magazine November/December 2012
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Texas. Department of State Health Services. Texas EMS Magazine, Volume 33, Number 6, November/December 2012, periodical, November 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth541925/m1/28/: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.