Test 3: Bell's Palsy & Trigeminal Neuralgia

True or False : Trigeminal neuralgia is twice as likely to occur in women than it does in men

*true*

Bell's Palsy Goals include...

- Maintain muscle tone of the face - prevent or minimize denervation - make sure it isn't a stroke and *reassure ptt. that it isn't one*

Eye care includes ...

- cover eye with shield at night - Close paralyzed eyelid manually before sleeping - apply eye drops during the day - apply eye ointment at bedtime - wraparound sunglasses / goggles

Some manifestations of trig. neuralgia include...

- facial pain - chewing dysfunction - loss or diminished corneal reflex

1/3 of patients who don't recover may have residual effects that include ....

- facial weakness - involuntary movement - tearing of eye on effected side

Surgical Post op care

- neruologic checks - pt. shouldnt rub eye (may injure the area and not know it due to loss of sensation around the area) - don't chew on affected side UNTIL numbness goes away

Bell's Palsy results in ________ or ________ of the facial muscles on the affected side

results in *weakness or paralysis* of the facial muscles

Usually in trigeminal neuralgia, the first episode is sudden with a ..........

sudden with a *memorable onset*

______ and _____ nerve branches are usually the ones affected in trigeminal neuralgia

*2nd and 3rd* nerve branches

____ _____ is an acute peripheral facial paralysis due to unilateral inflammation of the *7th cranial nerve* (facial nerve)

*Bell's Palsy* - 7th cranial nerve

What is the *hallmark* sign of bell's palsy?

*Bell's Phenomenon*

_________ ____________ is the inability to close the eyelid with an upward movement of the eyeball when closure is attempted

*Bell's Phenomenon* - they can't close their eye

True or False : Most pt.s *DO NOT* recover completely

*FALSE* - most pt. do recover completely - usually 3-5 weeks

True or False : Bell's Palsy comes on slow and takes time to develop

*FALSE* - onset is *sudden with rapid onset* - occur within a few hours - max facial weakness in 2days

__________ ___________ is a condition affecting the *5th cranial nerve*

*Trigeminal Neuralgia*

Bell's Palsy is caused by ?

*Unknown* (some theories include) - Acute demyelination (like guillain barre) - Infections (flu, mumps, epstein-barr, rubella) - Atherosclerosis - Pressure Paralysis (inflamed nerve & swelling)

__________ stimulation may be applied to the face for bell's to help prevent muscle atrophy

*electrical* stimulation

Diagnosis for bell's is done by ________

*exclusion* - there is no definitive dx. test - want to make sure it isn't stroke or tumor (rule out) - rule out via CT &/or MRI

After nerve sensitivity to touch has gone away, you want to teach the pt. what?

*facial massage* - gentle upward motions several times / day

____________ may be used to reduce inflammation & edema, restore blood circulation to the nerve, and with early admin. can diminish the severity

*prednisone* (corticosteroid)

Why might an MRI be used for someone with trig. neuralgia?

*rule out* - MRI with / without contrast to rule out other causes

Bell's Palsy Manifestations

- one sided facial paralysis - decreased tearing - Pain sensation in the face - Speech difficulties - tongue numb - may be unable to eat on affected side - headache - hearing difficult

Antiseizure meds can be used for what reason?

- relieve pain - reduce transmissino of impulses at certain nerve terminals *time meds to be pain free when they want to do shave/eat/brush*

Any stimulation of the terminals of affected nerve branches cause the symptoms, some of which include.... (*5th cranial nerve*)

- washing the face - shaving - brushing teeth - eating - drinking - direct cold air - pressure

What are some facial exercises the pt. may do? (*prevent atrophy*)

- wrinkling forehead - blow out their cheeks - whistle - avoid direct cold/wind to face (practice with a mirror)

What does *trigeminal neuralgia* cause?

Sudden, *unilateral*, severe, brief, stabbing, shooting or burning *pain* in the area innervated by *any of the 2 trigeminal nerve branches*

For trigeminal neuralgia, if meds fail to relieve the pain, what else can be done?

Surgical Procedure - based on pt. preference & health - decompresses the nerve - saves nerve function

a ______ ______ is a painful episode that is usually initiated by a triggering mechanism of light touch at a *specific point*

a *trigger zone*

Why is eye care important with bell's palsy?

because the pt. is *unable to close their eye*

Both _____ & _____ components of the facial nerves are affected regarding *Bell's Palsy*

both *motor & sensory* are affected

Why was trigeminal nerualgia's former name *tic douloureux*? (means painful twitch)

can cause *involuntary contraction* of facial muscles causing a sudden *closing of the eye* or *twitching of the mouth*