2-37. BELL’S PALSY

a. Definition. Bell’s Palsy is a cranial nerve disorder characterized by facial paralysis. Peripheral involvement of the 7th cranial nerve (facial nerve) produces weakness or paralysis of the facial muscles. The cause of this condition is unknown, but the majority of patient’s have experienced a viral upper respiratory infection 1 to 3 weeks prior to the onset of symptoms. Complications associated with Bell’s palsy include facial weakness, facial spasm with contracture, corneal ulceration, and blindness.

b. Signs and Symptoms.

(1) Distortion of face.

(2) Numbness of face and tongue.

(3) Overflow of tears down the cheek from keratitis caused by drying of cornea and lack of blink reflex.

(4) Decreased tear production that may predispose to infection.

(5) Speech difficulty secondary to facial paralysis.

c. Nursing Care Considerations.

(1) Objectives of care:

(a) Maintain muscle tone of the face.

(b) Prevent or minimize denervation.

(2) Protect the involved eye.

(a) If blink reflex is absent, eye is vulnerable to dust and foreign particles.

(b) Instill artificial tears (methylcellulose) to protect the cornea.

(c) Increase environmental humidity.

(d) Instruct patient to close affected eye frequently using accessory facial muscles.

(e) Instruct patient to wear a protective patch at night. (Keep in mind that patch may eventually abrade cornea as paralyzed eyelids are difficult to keep closed.)

(f) Instruct patient to wear protective glasses to further protect eye and decrease normal evaporation of moisture from eye.

(3) Administer steroid therapy, as ordered. (May reduce inflammation and edema and restore normal blood circulation to the nerve.)

(4) Provide for pain relief with analgesics and local application of heat.

(5) Facial massage may be prescribed to help maintain muscle tone.

(6) Surgical intervention may be necessary.

(a) Decompression of facial nerve.

(b) Surgical correction of eyelid deformities.

2-38. TRIGEMINAL NEURALGIA

a. Definition. Trigeminal neuralgia, also known as Tic Douloureux, is a disorder of the 5th cranial nerve (trigeminal nerve). It is characterized by sudden paroxysms of burning pain along one or more of the branches of the trigeminal nerve. The pain alternates with periods of complete comfort.

b. Signs and Symptoms.

(1) Sudden, severe pain appearing without warning. (Along one or more branches of trigeminal nerve.)

(2) Numerous individual flashes of pain, ending abruptly and usually on one side of the face only.

(3) Attacks provoked by pressure on a “trigger point” (the terminals of the affected branches of the trigeminal nerve). Such triggers include:

(a) Shaving.

(b) Talking.

(c) Yawning.

(d) Chewing gum.

(e) Cold wind.

c. Care Considerations.

(1) Instruct patient to avoid exposing affected cheek to sudden cold if this is known to trigger the nerve. For example, avoid:

(a) Iced drinks.

(b) Cold wind.

(c) Swimming in cold water.

(2) Administer drug therapy, as ordered.

(a) Tegretol or Dilantin–relieves and prevents pain in some patients.

(b) Serum blood levels of drug are monitored in long term use.

(3) Surgical procedures to sever the affected nerve provide optimum pain relief with minimum impairment.

(4) Instruct patient in methods to prevent environmental stimulation of pain.

(a) Eat foods that are easily chewed and are served at room temperature.

(b) Avoids drafts and breezes.