Tag Archives: Bell’s palsy

Some Health Quaries & Answers

If the shoe fits
Q: I want to buy a sports shoe but they seem to range in price from less than Rs 500 to Rs 10,000. How do I know which one to buy?


A: When buying a sports shoe it is important to consider what you will be using it for. Is it to walk, run, for serious aerobics or just as a fashion statement?

If it is for exercise then you need to go to a sports store and ask for a shoe designed specifically for the particular activity you wish to do.

Look at a few shoes. Before selecting a shoe:

Look at it head on to make sure it is perfectly symmetrical.

See if the tongue is laced with the shoe. That way it will not slip around placing the eyelets in contact with your foot. That is potentially injurious.

Make sure the sole “gives” by bending the shoe.

There should be a little space between your toe and the tip of the shoe. Shoes do not “loosen” with use. Your foot will get damaged before that happens. Nor will you “grow” into a shoe that is too large.

Buy your shoe in the evening when your foot is slightly swollen from the days activity.

The colour is the least important criteria. With use, all shoes eventually become the same colour.
You may click to see : How to Choose Sports Shoes

Grey smoke
Q: My hair is prematurely grey — I am only 29 years old. My mother says it is because I started smoking in college. Is that true?

A: Your mother is right. The nicotine in cigarettes does cause premature greying. That is however the least of the problems it causes. It also weakens your bones, precipitates heart attacks and causes cancer.

Stroke effect
Q: My father had a stroke (brain attack) and now he mumbles his words. Food drools out of the side of his mouth when he eats. He also cannot close one eye.

A: Your father has lost the use of one side of his body. Paralysis of the eyelid muscles prevents him from closing his eye fully. Similarly, the muscles for speech and swallowing are affected.

He will improve to some extent with physiotherapy. You need to make sure that he does not have a second stroke by treating any pre-existing disease like diabetes, hypertension or high lipids that caused the first stroke.

You need to protect his eye by closing it manually, placing a gauze piece over it and taping it shut with medical tape.

Facial paralysis
Q: My forty-year-old aunt developed isolated paralysis of one side of the face. She opted for ayurvedic treatment and recovered. She is not diabetic nor does she have high blood pressure. What was wrong with her?

A: She seems to have developed a condition called Bell’s palsy, paralysis of the facial nerve. Quite often it is due to an infection with the Herpes virus. In 80 per cent cases recovery is spontaneous and complete. This is probably the category to which your aunt, fortunately for her, belonged.

Lens safety
Q: I want to use a pair of contact lenses to change the colour of my eyes. Is it safe?


A: These are called novelty lenses as they only have cosmetic value. If novelty contact lenses are not properly fitted or if care instructions are ignored, they can cause corneal damage and loss of sight. Eye infections can occur if the lenses are not thoroughly sterilised prior to each use.

This seems a high price to pay for an altered appearance. After all, beauty is in the eye of the beholder.

Shampoo time
Q: How often should I wash my hair?


A: It depends on how dirty your hair becomes, but three times a week is about average. There is no need to use a lot of shampoo. About a Re 1 coin sized dollop is sufficient.
You may click to see : How often should I wash my hair?

Fast food
Q: My son loves instant noodles. He eats them 3-4 times a day. He is 4 years old.


A: Noodles are a good snack once or twice a week, but they should not substitute for good wholesome home cooked food. Some times the instant variety of noodles contains preservatives or ajinomoto. Both these ingredients are best avoided in children’s food.

Rash shave
Q: I got a shave at a barber shop and now, after two weeks, I have developed boils and rashes all over my beard area.

A: This is a very common infection which is either due to the bacteria S. aureus, or a fungus or due to ingrowth of thick beard.

It responds well to hot fomentation, cleansing with a bactericidal soap and local application of ointment. A dermatologist can usually determine accurately whether the infection is fungal or bacterial and prescribe the appropriate ointment. Applying steroid cream will worsen the condition. It usually clears up in a few weeks but can recur. It is probably better to shave at home.

Source : The Telegraph (kolkata, India)

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Bell’s Palsy

Definition:-
Bell’s palsy or idiopathic facial paralys  is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell’s palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell’s palsy is the most common acute mononeuropathy (disease involving only one nerve) and is the most common cause of acute facial nerve paralysis.

click to see

Bell’s palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day. It can occur bilaterally resulting in total facial paralysis in around 1% of cases.

It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell’s palsy has been found.

Corticosteroids have been found to improve outcomes while anti-viral drugs have not. Early treatment is necessary for steroids to be effective. Most people recover spontaneously and achieve near-normal to normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision. In some cases denture wearers experience some discomfort.

Bell’s palsy occurs when the nerve that controls facial muscles on one side of your face becomes swollen or inflamed. As a result of Bell’s palsy, your face feels stiff. Half your face appears to droop, your smile is one-sided, and your eye resists closing.

Bell’s palsy can affect anyone, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell’s palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell’s palsy, sometimes on the other side of the face. A small number of people continue to have some Bell’s palsy signs and symptoms for life.

Bell’s palsy occurs more often in people who:

*Are pregnant, especially during the third trimester, or who are in the first week after giving birth
*Have diabetes
*Have an upper respiratory infection, such as the flu or a cold

Also, some people who have recurrent attacks of Bell’s palsy, which is rare, have a family history of recurrent attacks. In those cases, there may be a genetic predisposition to Bell’s palsy.

Symptoms:
Bell’s palsy is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.

The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue.

Clinicians should determine whether the forehead muscles are spared. Due to an anatomical peculiarity, forehead muscles receive innervation from both sides of the brain. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy). If the problem resides in the facial nerve itself (peripheral palsy) all nerve signals are lost on the ipsilateral (same side of the lesion) half side of the face, including to the forehead (contralateral forehead still wrinkles).

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).

Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.

The main symptom of Bell’s palsy is a sudden weakness or paralysis in one side of your face that causes it to droop. This may make it hard for you to close your eye on that side of your face.

Other symptoms include:

*Drooling.
*Eye problems, such as excessive tearing or a dry eye.
*Loss of ability to taste.
*Pain in or behind your ear.
*Numbness in the affected side of your face.
*Increased sensitivity to sound.
*Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days — making it difficult to smile or close your eye on the affected side
*Facial droop and difficulty making facial expressions
*Pain around the jaw or in or behind your ear on the affected side
*Increased sensitivity to sound on the affected side
*Headache
*Changes in the amount of tears and saliva you produce

In rare cases, Bell’s palsy can affect the nerves on both sides of your face.


Cause
:-
Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g. the Zoster virus of the face and Epstein-Barr viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell’s palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress – emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) – in short, a host of different conditions, may trigger reactivation.

Other viruses that have been linked to Bell’s palsy include:

*The virus that causes chickenpox and shingles (herpes zoster)
*The virus that causes mononucleosis (Epstein-Barr)
*Another virus in the same family (cytomegalovirus)

With Bell’s palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen — usually from a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Pathology:
It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy. In a few cases, bilateral facial palsy has been associated with acute HIV infection.

In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell’s palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research[5] however, identifies HSV-1 in only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell’s Palsy. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell’s palsy therefore remains a hypothesis that requires further research.

In addition, the herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above mentioned – that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune system response. The quote below captures this hypothesis and the implication for other types of treatment:

It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be also effective.

Diagnosis:-
Bell’s palsy is a diagnosis of exclusion; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell’s palsy is commonly referred to as idiopathic or cryptogenic, meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell’s Palsy diagnosis likely spans different conditions that our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of etiology, treatment options, recovery patterns etc. See also the section below on Other symptoms. Studies   show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.

Risk Factors:
Although a mild case of Bell’s palsy normally disappears within a month, recovery from a case involving total paralysis varies. Complications may include:

*Irreversible damage to your facial nerve
*Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you’re trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
*Partial or complete blindness of the eye that won’t close, due to excessive dryness and scratching of the cornea, the clear protective covering of the eye.

Treatment:=
In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. Patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated. Early treatment (within 3 days after the onset) is necessary for therapy to be effective.[9] Steroids have been shown to be effective at improving recovery while antivirals have not.

Steroids
Corticosteroid such as prednisone significantly improves recovery at 6 months and are thus recommended.

Antivirals
Antivirals (such as acyclovir) are ineffective in improving recovery from Bell’s palsy beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell’s palsy and the herpes simplex and varicella zoster virus.

Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery
One way to relieve the pressure on the facial nerve is to surgically open the bony passage through which it passes. This decompression surgery is controversial and rarely recommended. In some cases, however, plastic surgery may be needed to make your face look and work better.

Home Remedy  & Lyfe Style:
Home treatment may include:
*Protecting the eye you can’t close. Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.

*Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help ease your pain.

*Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.

*Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist’s advice may help relax your facial muscles.

Alternative medicine:
Although there’s little scientific evidence to support the use of alternative medicine for people with Bell’s palsy, some people with the condition may benefit from the following:

*Relaxation techniques, such as meditation and yoga, may relieve muscle tension and chronic pain.

*Acupuncture, placing thin needles into your skin to relieve pain, may stimulate nerves and muscles, offering some relief.(The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).

*Biofeedback training, by teaching you to use your thoughts to control your body, may help you gain better control over your facial muscles.

*Vitamin therapy — specifically B-12, B-6 and zinc — may help nerve growth

Prognosis:
Even without any treatment, Bell’s palsy tends to carry a good prognosis. In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study found that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae. A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.

Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination – but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

In addition, around 6%[citation needed] of patients exhibit crocodile tear syndrome, also called gustatolacrimal reflex or Bogorad’s Syndrome, on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands. Gustatorial sweating can also occur.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Bell’s_palsy
http://www.mayoclinic.com/health/bells-palsy/DS00168
http://www.webmd.com/brain/tc/bells-palsy-treatment-overview

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Some Health Quaries & Answers

 

Q: My husband and I both have corns on our feet. His corns fell off after he applied corn caps. Mine did not even though I used the same caps. The caps keep falling off instead.

CORNY REMEDY :-

A: If the corn caps worked for your husband, trying the same brand makes sense. For self-treatment to be successful, the foot has to be dry when you apply the caps. Also, do not walk barefoot even in the house. When you have a bath, tie your leg in a plastic bag so that the caps do not get wet. You need to leave them on as long as possible.

Even though the lesions appear similar, in your case the diagnosis may be something else like warts. If they are still present after three months of self-treatment with corn plasters, consult a dermatologist and consider having them surgically removed.

HIS  FACE WAS PARALYZED :-

Q: My uncle was travelling in a car sitting next to the window. After he reached home he found that he could not move the right side of his face, or even close the eye. Is this a stroke?


A: This sounds more like “Bell’s palsy” than a stroke. It is an isolated paralysis of the facial nerve. It is common in persons between 15-60 years of age and in diabetics. It occurs because the facial nerve passes through a narrow bony canal in the ear before its branches enter the facial muscles. Exposure to cold can cause the nerve to swell up. It then becomes compressed. The pressure causes the paralysis. This can also occur as a result of an infection with the Herpes Simplex virus.

Treatment is with antiviral agents, steroids and physiotherapy. Recovery is usually complete.

POTTY TRAINING

Q: My six-year-old son has no control over his bowel movement. His pants and underwear are constantly soiled because part of the motion leaks out. It is not diarrhoea. This happens in school too, and it is becoming a problem.


A: If your son had control of his motion initially and has now lost it, he probably suffers from a condition called “encopresis”. It occurs when the child does not go to the toilet when he feels the urge. This results in chronic constipation. Once the rectum is full of impacted stools, liquid motion from above can leak out of the anus causing this problem.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movement. This means training your son to go to the toilet as soon as the urge to defecate occurs. Also, try to send him to the toilet every day at a fixed time.

The diet should contain dietary fibre in the form of four to five helpings of fruits or vegetables a day.

DARK PATCHES

Q: I developed dark patches on my arms and legs. I went to one of the clinics advertised on television and they diagnosed macular amyloidosis (I don’t know what that is) and advised laser treatment. I am a bit nervous about this.


A: Macular amyloidosis is a skin condition in which itchy lesions appear as flat dusky-brown or greyish spots that may eventually form patches of darkened skin. It is found symmetrically distributed over the upper back between the shoulder blades, on the chest, sometimes on the arms, and rarely on the legs.

The diagnosis has to be made after a biopsy. All dark patches are not macular amyloidosis (yours seem non-itchy) nor do they require expensive treatment like laser therapy. Go to a dermatologist, confirm the diagnosis and then start treatment. Usually anti histamines and topical steroids are tried initially. Do not believe everything said in advertisements on television.

CURE  FOR  PCOS

Q: My daughter has polycystic ovarian syndrome (PCOS). Each time the doctor puts her on tablets, and she is alright for a few months. As soon as the treatment is discontinued, her periods become irregular.


A: PCOS occurs because of an inherited abnormal gene for food metabolism. As a result the sufferer tends to become obese, develop acne and have irregular periods. The gene will always be present. The tendency to manifest the gene can be controlled if —

* Your daughter jogs 40 minutes a day

* She maintains her BMI at 23 (BMI is weight divided by height in metre squared).

Pills or exercise — the choice is hers.

ATTEMPTED  RAPE

Q: A relative tried to rape me during my childhood. Now I have abdominal pain all the time. I think I have an infection.


A: Since you are worried, and with reason, test your blood for VDRL, HIV and HbAg. Also, do an ultrasound of the abdomen and pelvis. If all these are normal, you have nothing to worry about.

Move on with your life and forget the past. Almost 95 per cent women face unwelcome unwanted sexual advances at some time in their life. Take lessons in karate, Kung Fu or some other martial art. It will make you more confident and ensure nothing like that happens again.

Source: The Telegraph ( Kolkata, India)

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Lagophthalmos

Synonym(s): Hare’s eye

[G. lagos, hare + ophthalmos, eye]

Definition:
Lagophthalmos is defined as the inability to close the eyelids completely. A condition in which a complete closure of the eyelids over the eyeball is difficult or impossible.

Blinking covers the eye with a thin layer of tear fluid, thereby promoting a moist environment necessary for the cells of the exterior part of the eye. The tears also flush out foreign bodies and wash them away. This is crucial to maintain lubrication and proper eye health. If this process is impaired, as in lagophthalmos, the eye can suffer abrasions and infections. Lagopthalmos leads to corneal drying and ulceration.

click to see the pictures...(01)…...(1).…(2)..…...(3).…...(4).…...(5)..….(6I).…..(7).....

Nocturnal lagophthalmos is the inability to close the eyelids during sleep. Lagophthalmos is associated with exposure keratopathy, poor sleep, and persistent exposure-related symptoms.

Detection:There are a variety of causes of lagophthalmos, grouped as proptosis/eye exposure etiologies and palpebral insufficiency etiologies. Although obvious lagophthalmos is usually detected, it is sometimes difficult to recognize obscure lagophthalmos, due either to eyelash obstruction or overhang of the upper lid anterior and inferior to the most superior portion of the lower lid in a closed position. A novel classification system and illustrations of obvious and obscure lagophthalmos for detection.

Causes:
The inability to provide function to the eyelid is typically secondary to a previous or ongoing condition, surgery, or event. This paralysis is usually isolated to just one side of the face. Lagophthalmos and facial paralysis are typically diagnosed due to:

*Bell’s Palsy
*Trauma
*Neurosurgery
*Bacterial infection
*Cerebral vascular accidents (strokes)

Pathophysiology
Lagophtalmos can arise from a malfunction of the Facial nerve. Lagopthalmos can also occur in comatose patients having a decrease in orbicularis tone, in patients having palsy of the facial nerve (7th cranial nerve), and in people with severe skin disorders such as ichthyosis.

Risk Factors:
Your eyelids play a crucial role in protecting and providing nourishment to your eyes. When blinking or eyelid closure function is lost, the health of your eyes can be at risk. Many experts have noted several complications associated with lagophthalmos:

*Severe dry eye and discomfort
*Corneal ulceration (damage to the cornea-the clear tissue covering the front of your eye)
*Decrease or loss of vision
*Unsatisfactory appearance

Diagnosis:

A diagnosis can usually be made with a focused history and slit lamp examination. Treatment is multipronged and may include minor procedures or ocular surgery to correct the lid malposition; natural, topical or oral agents; and punctal plugs to manage ocular surface effects. Correct and timely diagnosis allows greater opportunity for relief of patient suffering and prevention of severe ocular surface pathology, as well as educated planning for future ocular surgical procedures.

Treatment:
Today, lagopthalmos is most likely to arise after an inexperienced or unwise cosmetic/plastic surgeon performs an overenthusiastic upper blepharoplasty, which is an operation performed to remove excessive skin overlying the upper eyelid (suprapalpebral hooding) that often occurs with aging. This can appreciably improve the patient’s appearance, and make the patient look younger. If, however, excessive skin is removed, the appearance is unnatural and “lagopthalmos” is one of the signs of such excessive skin removal.

It all begins with your diagnosis of your condition by your ophthalmologist. Typically, if your paralysis is expected to last less than six months, your doctor will recommend the use of drops and ointments throughout the day to help maintain a well-nourished eye.

If your paralysis is deemed permanent or persists without improvement, your surgeon may want to perform surgery to control the paralysis and provide a more natural function to your eyelid. The most common surgical procedure involves the placement of a small, pure-gold eyelid weight into your eyelid. This procedure very simple and is typically performed under local anesthesia in an outpatient setting.

How Does The Gold Eyelid Weight Work?

It’s very simple. The appropriate implant ‘weight’ will be selected your physician. When implanted into your lid margin, the weight will essentially allow earth’s gravity to gently pull your eye closed when your muscles relax. However, this will not affect your ability to open your eye…. when you tense the muscle, your eyelid will open normally.

CLICK & SEE

Is Gold A Safe Material?
Each weight is made from 99.99% gold (pure gold). Pure gold is an excellent material because it is biologically stable and inert. Because the gold will never break down, your surgeon can always remove it if deemed necessary. Gold has been used for decades for the treatment of lagophthalmos and is recognized by experts as an extremely safe and effective device material. If you have a known sensitivity or allergy to gold, notify your physician before surgery.

What Happens During Surgery? How Is The Gold Weight Implanted?
Gold eyelid weight surgery is usually performed under local anesthesia in an outpatient setting. Previous to the day of the surgery, your physician will have selected the appropriate gold weight size for your specific needs.

During the procedure, your physician will first make a small incision in your eyelid, just above your eyelashes. This incision will allow your physician to create a small pocket inside your lid for the gold implant to rest. The weight will be secured to your lid with sutures. Each weight contains small channels or grooves to house the sutures below the surface of the implant. The incision is closed with sutures. A protective pad will be applied to cover your eyelid.

What Happens After Surgery? What Should I Expect Regarding The Function And Appearance Of My Eyelid?

As always, your condition and progress will be closely monitored by your physician. Following the removal of your eye protection, you should be able to experience normal blinking and eyelid closure function.

Like any surgery, the incision will take time to heal. If you experience significant discomfort or swelling around the incision, contact your physician immediately.

Any questions or concerns you have about your surgery can best be answered by your surgeon. You can best insure the best outcome for your procedure by carefully following your surgeon’s instructions.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Lagophthalmos
http://www.iopinc.com/patient_link/lagophthalmos.asp
http://www.drugs.com/dict/lagophthalmos.html
http://www.ncbi.nlm.nih.gov/pubmed/16671223

Bell’s Palsy

Other Name: Facial Palsy

Definition:
Bell’s palsy is a paralysis of the facial nerve resulting in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell’s Palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell’s palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause of acute facial nerve paralysis.

Bell’s palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day.

It is thought that an inflammatory condition leads to swelling of the facial nerve (nervus facialis). The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell’s palsy has been found, but clinical and experimental evidence suggests herpes simplex type 1 infection may play a role.

Doctors may prescribe anti-inflammatory and anti-viral drugs. Early treatment is necessary for the drug therapy to have effect. The effect of treatment is still controversial. Most people recover spontaneously and achieve near-normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision.

For many people, the first guess would be a stroke. But if your muscle weakness or paralysis affects only your face, a more likely cause is Bell’s palsy.

Each year, about 40,000 Americans develop Bell’s palsy, a condition that occurs when the nerve that controls the facial muscles becomes swollen or compressed. The problem can occur at any age, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell’s palsy symptoms begin to improve within a few weeks, with complete recovery within three to six months. Between 8 percent and 10 percent will experience a recurrence of the signs and symptoms, sometimes on the opposite side of the face. And a small number of people never recover and continue to have some signs and symptoms for life.

Investigation:
Bell’s palsy (or facial palsy) is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.

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Click to learn more about Bell’s Polsy ( Facial nerve & how it works etc.)

The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue.

Clinicians should determine whether all branches of the facial nerve are involved, or whether the forehead muscles are spared. Since forehead muscles receive innervation from both sides of the brain, the forehead can still be wrinkled by a patient whose facial palsy is caused by a problem in the brain (central facial palsy) but not if the problems resides in the facial nerve itself (peripheral palsy).

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, of the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).

Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.
Signs and symptoms:

Signs and symptoms of Bell’s palsy may include:

*Sudden onset of paralysis or weakness on one side of your face, making it difficult to smile or close your eye on the affected side

*Facial droop and difficulty with facial expressions

*Pain behind or in front of your ear on the affected side

*Sounds that seem louder on the affected side

*Pain, usually in the ear on the affected side

*Headache

*Loss of taste

*Changes in the amount of tears and saliva your body produces

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Other symptoms are:
Although defined as a mononeuritis (involving only one nerve), patients diagnosed with Bell’s palsy may have “myriad neurological symptoms” including “facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesias, ipsilateral limb weakness, and a sense of clumsiness” that are “unexplained by facial nerve dysfunction”. This is yet an enigmatic facet of this condition.

Causes:
It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy, and they exhibit many of the same symptoms as people with Bell’s palsy; this is often due to a traumatic birth which causes irreparable damage to the facial nerve, i.e. acute facial nerve paralysis.

In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell’s palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research[3] however, identifies HSV-1 in only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell’s Palsy,. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell’s palsy therefore remains a hypothesis that requires further research.

The herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above mentioned – that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune system response. The quote below captures this hypothesis and the implication for other types of treatment:

It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be effective.

Virus reactivation
Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g. Epstein-Barr virus of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell’s palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress – emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) – in short, a host of different conditions, may trigger reactivation.

Smile with Bell’s palsy..

The most common cause of Bell’s palsy appears to be the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell’s palsy include the virus that causes chickenpox and shingles (herpes zoster), the virus that causes mononucleosis (Epstein-Barr), and another virus in the same family (cytomegalovirus).

Diagnosis:
There is no specific laboratory test to confirm a diagnosis of Bell’s palsy. Your doctor may be able to make a preliminary diagnosis of Bell’s palsy by looking at your face and asking you to try to move your facial muscles.

Other conditions — such as a stroke, infections and tumors — also may cause facial muscle weakness, mimicking Bell’s palsy. If after a few days there’s still doubt about the diagnosis, your doctor may recommend other tests:

Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
Imaging scans. An X-ray, magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to eliminate other possible sources of pressure on the facial nerve, such as an infection, tumor or skull fracture.

Bell’s palsy is a diagnosis of exclusion; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell’s palsy is commonly referred to as idiopathic or cryptogenic, meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell’s Palsy diagnosis likely spans different conditions which our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of etiology, treatment options, recovery patterns etc. See also the section below on Other symptoms. Studies[1] show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.

Treatment:
Most people with Bell’s palsy recover fully — with or without treatment. But your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell’s palsy.

Treatment is a matter of controversy. In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. However, patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated with anti-inflammatory corticosteroids. Prednisolone, a corticosteroid, if used early in treatment of Bell’s palsy, significantly improves the chances of complete recovery at 3 and 9 months when compared to treatment with acyclovir, an anti-viral drug, or no treatment at all. The likely association of Bell’s palsy with the herpes virus has led most American neurologists to prescribe a course of anti-viral medication (such as acyclovir) to all patients with unexplained facial palsy, although a large study showed no additional benefit from acyclovir beyond that from prednisolone alone. Surgical procedures to decompress the facial nerve have been attempted, but have not been proven beneficial. Acupuncture has also been studied, with inconclusive results.

A practice parameter from the American Academy of Neurology states that “corticosteroids are safe and probably effective, and that acyclovir is safe and possibly effective”. Early treatment (ie, within 3 days after the onset) is necessary for acyclovir-prednisone therapy to be effective. If the patient presents 10 days after the onset of symptoms, no drug treatment is necessary. (ibid.)

Medications:
Study results have been mixed regarding the effectiveness of two types of drugs commonly used to treat Bell’s palsy — corticosteroids and antiviral medications.

Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. If Bell’s palsy is triggered by a virus, then an antiviral drug — such as acyclovir or valacyclovir — may stop the progression of the viral infection.

Some clinical studies show benefit from early treatment with corticosteroids, antivirals or a combination of both types of drugs. Other studies do not. Evidence of the effectiveness of corticosteroids appears to be stronger than that for antiviral drugs.

Physical therapy :
Paralyzed muscles can shrink and shorten, causing permanent contractures. Massaging and exercising your facial muscles may help prevent this from occurring. Moist heat may help relieve pain.

Alternative medication:

Some people with Bell’s palsy may benefit from:

*Relaxation techniques
*Acupuncture
*Biofeedback training
*Vitamin therapy — specifically B-12, B-6 and zinc
*In traditional Chinese medicine, Bell’s palsy is attributed to a “wind cold” attack brought about by exposure to wind.

Recovery:
Even without any treatment, Bell’s palsy tends to carry a good prognosis. In a study of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study finds that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae. A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.

Self-care:
If you can’t close your eye, you’ll need to keep the eye moist with hourly eyedrops during the day and an eye ointment at night. If the clear protective covering of the eye — called the cornea — becomes too dry, it can cause permanent vision loss. Your doctor may want you to wear glasses or goggles during the day and an eye patch at night to protect your eye from getting poked or scratched.

Complications:
Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the reflex is also affected; great care should be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections which branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination – but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

In addition, around 6% of patients exhibit crocodile tear syndrome on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands.

Click to learn how to do facial exercise

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Bell’s_palsy
http://www.mayoclinic.com/health/bells-palsy/