Looks like Bilateral Facial Palsy !

[emad]

Hi all ;

Do you think facial palsy ( Lower Motor Neuron ) could occur bilateral ? Take the whole Face .

The joke of that person the mouth does not deviate to any side in laughing /like mask face !!!

Since 3 days i meet a female ,23 years , referred as Facial palsy .
when i began to assess i found that she can not close both her eyes .

I am convinced that she is Right Facial palsy ,Only .

and the dentist who she visited has injuried her left facial nerve , but the injury is not complete .

Do you think the dentist may injury her left facial nerve ??

cheers
Emad

[bernard]

Hello Emad,

The case seems very strange for me!
I saw many cases of Bell's palsy but none bilateral.

You're saying that a dentist made some cares with her and it would be interesting to known what kind of cares it was because, for an example, a large/inappropriate use of anaesthetic may produce a paresis/palsy for hours/days, even bilateral, in this way.

More, why did she consulted the dentist? Certainly for a tooth/teeth problem? How long before consulting? It is possible also that her teeth's state is not very good both sides. It will bring some problems both sides!

You're saying that, in your opinion, the problem is only right sided that it is sensible but to give a more directive opinion I need some more clues.

[emad]

Hi Bernard:

Where I live ,The patient can visit any Specalist , I mean there is no service called GP ( gate keeper ) , so in 5 years of physiotherapy practice full with Facial pals cases i meet around 5 cases visited A dentist , as they think in the first day of the Facial palsy ,they are suffering some thing in their teeth , They do not know , who to visit , and here any one can work anything , the dentist say to him/her self ,what the Neurologsit will do more than me , he/she will give the Anti_inflammatory ,moreover the Bell s Palsy if stayed in the house without health care ,it will cured in 6 weeks.

Back to our case :

She is female 23 years .

I asked her , before you visted the Dentist ,was there any thing in your face , she replied yes .
She visited the Dentist , who took off one of her back teeth ( bigger teeth , i do not know its name in English ) at the left side .

Right Side :
is complete facial palsy , with inability to rise the eye brow , can not close the eye .

Left side :
more affected the area around the mouth , the eye can be closed more better than the right eye .

No tenderness behind both ears ( mastoid process)


The neurologist who assessed the case thinks that , there is central Hypothesis , but i think this Neurologist do not know any thing in Medicine , this in General in all cases i see after him.

I assessed her mouth , using my fingers , from my observation , she has no complaint at all , all her teeth are in ver good state , only from my observation .

cheers
Emad

[bernard]

Hello Emad,

You said that the opposite side was already ill before consulting. So, since how long time?
Facial palsy touches rarely (but does sometimes) eyes it is why, perhaps the neurologist said it was a central problem?

If it is a normal Bell's palsy then it will recover in time told but if it is not then you may suppose that a central origin is possible.

A good clue will to know the duration of the left eye problem.

[emad]

Hello Bernard:

Thank you for going on to dicuss the case .

The last time, i saw that patient since about 4 days , i referred her to her Neurologist ( because i see she selected that Neurologist on the basis of culture reasons not professional bases, however sometimes i feel every patient has the right to select even if that selection has side effects on the patient himself ), as i see her in Public work , which usually we do not do accurately in the Third World !!

Well ,back to our scientific discussion , if you think there is a central factor Like what my dear friend ??

yes , i saw before the facial nerve involvement in a case of Brain tumor , but it was so clear the Upper Motor Neuron case facial palsy is so clear tkes only the mouth ( face lower qarter ) in cases like Crossed Hemiplegia , On the other hand The lower Motor Neuron Asscoiated facial palsy takes the Whole half of the face .

By the way , I think the whole case took , now , around one month , and it is stable state currently . I believe if it is upper Motor neuron /central case the whole issue will be progressive.

The last time, i saw her ,she concluded before she visited the Dentist , there great inflammation ,swelling and pain in her teeth ( left side ).

Bernard , I believe the main problem behind my current case ,is the NOn-recording strategy in our health system and no team wotk strategies .

Thanks , I will be on for that case , i choosed to write that case because i find it very strange .

cheers
Emad

[Thomas]

Greetings Emad, :D

It has been my understanding (perhaps incorrectly) that most physical therapy approaches for facial palsy are ineffective(?)

How do you go about treating these customers as you state you have seen many over 5 years? In our clinic they are treated with orofacial exercises during which time they are receiving motor point stimulation.
(Treated by speech therapist who claims good results , unsure if there is any evidence).


Cheers...........Thomas

[emad]

Hello Thomas :

yes , as i see , weekly i see in my private clinic 5 cases , and more than 10 in the public hospital .

For 3 years i used to treat the facial palsy using electro therapy as i learned in undergraduae school , but the following 2 years i found website in Europe perscribing these orofacial ex , which i used since hen and i developed them , actually there is great difference in the outcome and time and cos effectivness.

For example ;
Currently , i have a case of facail palsy 6 months , she received electro and drugs , she was so so so afraid when she intial visited me , because of the pain she expereinced in the way physioherapists her applying physio , i calimed her , then performing these facial ex s , in 20 days she experienced around 30 % improvement , all muscles began to move .In conclusion , these ex s are very effective , but also there are cases of Bell s palsy could improve without any medicine and physio , all depends on the degree of nerve injury /affect.


As well , i want to add another case , i failed with her , she is 55 years , wih past history of Radiotherapy recieving behind he Ear , over he Mastoid process and facial palsy of the same side , when i assessed her after 2 months of facial palsy onset , the skin mobility behind the ear is lost , i tried with her using these facial ex s for one month , i found no progress , she now recieving electro herapy with anoth physiotherapis, as i refused to apply electro .

Also , i met more than 10 cases had facial palsy as a complication following ENT operations( ear operations ) , these cases are the worst , no progress at all.

cheers
Emad :)