International Research Journal of Pharmacy and Pharmacology

Case Study of Bell’s Palsy

Mekala Anusha^1*, M Jhansi², Tharuna Sri Priya² and Aliveni Patlola^{3 1}Department of Pharmacy Practice, Malla Reddy College of Pharmacy, Telangana, India
²Department of Pharmacy Practice, MNR College of Pharmacy, Telangana, India
³Department of Pharmaceutical Analysis, Arya College of Pharmacy, Telangana, India
^*Corresponding Author:
Mekala Anusha, Department of Pharmacy Practice, Malla Reddy College of Pharmacy, Telangana, India, Email: Anushayadav010@gmail.com

Received: 19-Jan-2024, Manuscript No. IRJPP-24-125425; Editor assigned: 23-Jan-2024, Pre QC No. IRJPP-24-125425 (PQ); Reviewed: 06-Feb-2024, QC No. IRJPP-24-125425; Revised: 22-Jan-2025, Manuscript No. IRJPP-24-125425 (R); Published: 29-Jan-2025, DOI: 10.14303/ 2251-0176.2025.31

Introduction

Bell’s palsy is a neuropathy involving the 7th cranial nerve own as facial nerve (Bell, 1821). It was 1st described by Dr. Charles Bell in 1821. Bell’s palsy is usually unilateral and can be complete or partial which can be affected equally (Singhi et al., 2003). Bell’s palsy is defined as idiopathic unilateral facial nerve paralysis, usually self-limiting (Ahmed, 2005). In most of the cases, the weakness is temporary and significantly improves over weeks (Grose et al., 1975). The weakness makes half of the face appear to droop (Belec et al., 1989).

Etiology

Common viral cause of Bell’s palsy is Herpes Simplex Virus (HSV) but there are several reports of other viruses such as Epstein bare virus, human immunodeficiency virus and Hepatitis B Virus involved in with similar presentation (de Diego et al., 2005).

Epidemiology

It affects 11.5-53.3 per 1,00,000 individuals a year across different populations which affects individuals across multiple ages and both sexes (Doner et al., 2000). The incidence increases with age (Peitersen, 2002). Familial inheritance found in 4-14% of cases. The Incidence of Bell’s Palsy reaches a maximum between ages 15-45 years, the disease is significantly less common below the age of 15 years and above the age of 60. The risk of bell’s palsy is increased in diabetes, upper respiratory tract infection ad pregnancy (Tovi et al., 1986). In December 2020, the U.S.FDA recommended that recipients of Pfizer and moderna COVID-19 vaccines should be monitored for symptoms of Bell’s palsy after several cases were reported among clinical trial participants though the data were not sufficient to determine a causal link (Higgins et al., 2020).

Signs and symptoms

Bell’s palsy is characterized by a one sided facial droop that comes on within 72 hours (Baugh et al., 2013). The facial nerve controls a no of functions such as blinking and closing the eyes, smiling, frowning, lacrimination, salivation, flaring nostrils, raising eye brows, causing normal sounds to be perceived as very loud (hyperacusis & dysacusis) (Mumenthaler et al., 2006).

Treatment

The standardized treatment for Bell’s palsy is based on following criteria:

• Bell’s palsy (LMN 7th CN)

Physically diagnosed based on symptoms and laboratory diagnosed from MRI scan (DNS –Deviated Nasal Septum) towards left side is noted. Mild prominence of bilateral ventricles otherwise (Tables 1-3) (Moore et al., 2013).

Table 1. Physically diagnosed based on symptoms and laboratory diagnosed from MRI scan (DNS –Deviated Nasal Septum) towards left side is noted.

• Pyrexia (diagnosed based on elevated temperature 102°F, Goal temp <98.6°F

Table 2. Diagnosed based on elevated temperature 102°F, Goal temp <98.6°F.

• Lagopthalmos (diagnosed based on complaints inability to close eyelid) which leads to corneal exposure and excessive evaporation of tear film.

Table 3. Diagnosed based on complaints inability to close eyelid) which leads to corneal exposure and excessive evaporation of tear film.

Case Study

A patient of 21 years old male patient was admitted in Malla reddy heath city hospital, suraram, Telangana, India with complaints of deviation of mouth to left since morning, inability to close right eye lid since morning, pain in anterior neck, difficulty in chewing food, developed fever spikes within 2 days.

H/O of present illness

Patient had a history of RTA trauma to head 4 years ago.

Physical examination

At time of admission, his body temperature was 102°F, BP 100/60 mmHg, Pulse rate -82 beats/min and respiratory rate was 14/min, CNS -7th CN LMN, Abnormal reflexes.

Therapy

Tab. Methyl Prednisolone which is a corticosteroid can reduce the swelling in the facial nerve. Tab. Acyclovir antiviral in combination with prednisolone benefit the patient. Refresh eye drops, patient should instill 1-2 drops in the eye 2nd hourly. Tab.Pan should be taken before breakfast to reduce the amount of acid produced in stomach. Tab. Dolo helps to reduce fever spikes that developed (Table 4).

Table 4. Drugs with their therapy.

Discussion

Physician and Pharmacist should spend enough time to provide information to the patient about the disease condition along with the treatment modalities both and physiotherapy. In case of busy schedule of physician, the clinical pharmacist should take role to spend quality time with the patient for assessment of knowledge and attitude towards Bell’s Palsy and to provide patient counseling by suggesting hand hygiene, personal protection, using mask, implementing information control protocols to reduce exogenous transmission by using appropriate probiotics if ward is provided with infectious disease cases. Lactobacillus rhamnose Bifidobacterium administration in dose of at least 5 colony forming units per day during hospital stay.

Conclusion

Patient recovering from symptoms and condition improved. In this study patient vitals were normal and lubricating eye drops during day and eye ointment at night will helps the eye to keep moist. Physiotherapy on right side of face helps to relieve facial paralysis.

Acknowledgement

I would like to thank my principal Sudhakar sir, for his guidance, encouragement and advice and for the facilities provided.

References

1. Bell C (1821). On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Phil Trans R Soc Lond. 111: 398–424.

   [Google Scholar]

2. Singhi P, Jain V (2003). Bell's palsy in children. Semin Pediatr Neurol. 10: 289–297.

   [Crossref] [Google Scholar] [PubMed]

3. Ahmed A (2005). When is facial paralysis Bell palsy? Current diagnosis and treatment. Cleve Clin J Med. 72: 398–401.

   [Crossref] [Google Scholar] [PubMed]

4. Grose C, Henle W, Henle G, Feorino PM (1975). Primary Epstein-Barr-virus infections in acute neurologic diseases. N Engl J Med. 292: 392–395.

   [Crossref] [Google Scholar] [PubMed]

5. Belec L, Gherardi R, Georges AJ, Schuller E, Vuillecard E, et al (1989). Peripheral facial paralysis and HIV infection: Report of four African cases and review of the literature. J Neurol. 236: 411–414.

   [Crossref] [Google Scholar] [PubMed]

6. de Diego-Sastre JI, Prim-Espada MP, Fernandez-Garcia F (2005). The epidemiology of Bell’s palsy. Rev Neurol. 41:287–290.

   [PubMed]

7. Doner F, Kutluhan S (2000). Familial idiopathic facial palsy. Eur Arch Otorhinolaryngol. 257(3): 117–119.

   [Crossref] [Google Scholar] [PubMed]

8. Peitersen E (2002). Bell’s palsy the spontaneous course 2,500 peripheral facial nerve palsies of different aetiologies. Acta Otolaryngol. 549: 4–30.

   [Google Scholar] [PubMed]

9. Tovi F, Hadar T, Sidi J, Sarov I, Sarov B (1986). Epidemiological aspects of idiopathic peripheral facial palsy. Eur J Epidemiol. 2(3): 228–232.

   [Crossref] [Google Scholar] [PubMed]

10. Higgins-Dunn, Noah (2020). FDA staff recommends watching for Bell's palsy in Moderna and Pfizer vaccine recipients. CNBC.
11. Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, et al (2013). Clinical practice guideline: Bell's Palsy executive summary. Otolaryngol Head Neck Surg. 149(5): 656–663.

    [Crossref] [Google Scholar] [PubMed]

12. Mumenthaler M, Mattle H (2006). Fundamentals of Neurology. 2nd Edition. Thieme Publisher. Germany. 197.
13. Moore KL, Dalley AF, Agur AM (2013). Clinically Oriented Anatomy. 7th Edition. Lippincott Williams & Wilkins. Pennsylvania, US state.