Facial nerve paralysis is a devastating problem for those affected. Few areas in dental neurology have been as controversial as the management of Bell's palsy. The past several decades have witnessed many theories about the etiology and pathogenesis of Bell's palsy. In concert with each of these theories has been an appropriate management scheme. Because of the nature of the literature, it has been difficult for clinicians to unequivocally outline management algorithms.
Think about the causes of Bell's and then try and work out how you would treat a patient with Bell's. Specifically, lets hear your thoughts on:
- The management of drooling
- Masticatory problems
- Speech problems
- Swallowing
- eye problems.
1 comment:
Most of the treatments I found for drooling I thought were a bit too extreme to use in the case of Bell’s palsy seeing that for most people this condition is only temporary. I think that the only treatment I would recommend would be drugs to decrease saliva production (atropine, hyoscine) or the injection of butulinum toxin into the salivary gland. The draw back here of course is the possible detrimental effect a reduced saliva flow would have on oral health. To assist with mastication I would advise the patient to direct food only to their unaffected side to prevent accidental biting of the cheek or tongue (as with local anesthesia), and perhaps to avoid hard foods that require a lot of force (eg: apples). Good hygiene would also be important because food would probably get stuck around the buccal sulci of the paralyzed side. If the patient were following any of the saliva reduction therapies then this would be an added problem to mastication so use of a liquid during eating may help (does lead to the problem of the liquid dribbling out again though!!) The reduced saliva flow would also interfere with speech. In regards to the paralysis of the muscles, the patient could see a speech therapist who may have some suggestions as to how to improve speech during this time. I would recommend some kind of covering to protect the eye (sunglasses or an eye pad), and eye lubricants to stop it drying out. Also tapeing the eye shut would help the patient sleep at night.
I found it hard to think of treatments that were not too invasive and extreme for something that is frequently only temporary – I can see how this is a very difficult problem to manage!!
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