Journal of Applied Dental and Medical Sciences

NLM ID: 101671413 ISSN:2454-2288

Volume 4 Issue 4 October-December 2018
Review Article

Bell’s Palsy and Its Prosthodontic Significance

Renu Gupta 1, R.P. Luthra 2, Abhishek 3, Bhavya Aggarwal4
1
Professor and Head, Dept. of Prosthodontics, HP Govt. Dental College, Shimla, HP, India
2
Professor and Head, Dept. of Dentistry, Dr Y.S. Parmar Govt. Medical College, Nahan, HP, India
3
PG-2nd year, Dept. of Prosthodontics, HP Govt. Dental College, Shimla, HP, India
4
MBBS 1st year, Govt. Medical College, Amritsar, Punjab, India.

ARTICLE INFO ABSTRACT

Rehabilitation of compromised patient has always been a challenge to the medical field. Prosthodontic
management in a facial palsy patient is a difficult task to accomplish.This requires alteration of
conventional procedures. This article presents bells palsy ,its etiology,symptoms , prosthodontic
significance and discussed the most effective methods of treating such dental patients.

Keywords:
Bell‟s palsy, Prosthodontic

INTRODUCTION peripheral lesion. It starts in the motor nucleus [namely,

The most common cause of acute unilateral facial intra-nuclear lesions], both peripheral facial nerve
paralysis (60 - 75% of cases) is Bell”s palsy. World branches are injured and facial palsy is located in the
wide, it is one of the most common neurologic disorders homolateral hemi face in case of peripheral lesion and in
of the cranial nerves and it is the most common cause of the motor cortex from the ascending frontal convolution
facial paralysis. Sir Charles Bell described the name up to the facial nerve nucleus in the pons (i.e. in case of
„Bell”s palsy. It is an unilateral idiopathic lower motor supranuclear facial injuries) in case of central lesion, the
neuron paralysis of the facial nerve of sudden onset. On lower branch of the facial nerve is affected because the
the affected side of the face ,it involves loss of muscular upper part of the nucleus receives both homolateral and
control. Sir Charles Bell, in 1821 demonstrated the contralateral cortical afferent pathways and
separation of the sensory and motor innervation of the extrapyramidal ones. The motility of the lower face is
face and describe the function and anatomy of the facial impaired in central facial paralysis1 .
nerve .
Ranging from partial and mild forms to complete form HISTORY
facial paresis and facial paralysis are dysfunctions of - Greek physicians gave brief accounts of these
different degrees of the facial nerve . Paralysis of facial disorders.
nerve is defined as severe or complete loss of facial - Hippocrates (5th century BCE) in the book
muscle motor function. This may result from central or Prorrhetics II, stated “Distortions of the face, if they

* Corresponding author: Dr. Abhishek, PG-2nd year, Dept. of Prosthodontics, HP Govt. Dental College, Shimla, HP, India
 59

coincide with no other disorder of the body, quickly - unilateral facial palsy that bears his name.
cease, either spontaneously or as the result of Sir Charles Bell, for whom the condition is named,
treatment. presented three cases at the Royal Society of
- Areteaus (Greek physician, 1st century CE) London in 1829. Two cases were idiopathic and the
described paralysis, including parts of the face. third was due to a tumour of the parotid gland.2
-
Aulus Cornelius Celsus (1st century CE) described
it as cynic Spasm. ETIOLOGY
- nd
Archigenes (1st or 2 century CE) also gave an The etiology remains unclear. Various causes have been
account of facial paralysis in conjunction with cynic proposed which include viral,autoimmune ,inflammatory
spasm. and vascular herpes zoster oticus (Ramsay Hunt
-
Galen (2nd century CE) described spasm of syndrome) ,trauma and the rarer causes including otitis
the“lips, eyes, skin of the forehead,cheeks and root media, sarcoidosis, HIV infection, autoimmune
of tongue hemifacial paralysis associated with brain disorders or tumours of the parotid gland3, Lyme‟s
lesions, and isolated paralysis of specific areas disease and Guillain–Barré syndrome. 20% of reported
(“tongue, eyes, jaws, or lips) cases of facial palsies have a known etiology4 . The
-
Caelius Aurelianus (5th century CE) separately most common upper motor neuron cause of facial
detailed (probably following Galen‟s lead) eyebrow, paralysis is stroke and iatrogenic cause is through the
tongue, lip, and jaw muscle paralysis. administration of an inferior alveolar nerve block
-
Shoja et al. provides a translation of al-Hawi mainly.3
regarding facial palsy.
- Persian physicians, such as Ibn Sina (980–1037 CE) CLINICAL FEATURES
and Jorjani (1040– 1136 CE), reiterated condensed  On the affected side, there is paralysis and
versions of al-Hawi,at times verbatim and without weakness of the upper and the lower facial muscles.
identifying the source. There is drooping of the ipsilateral eyelid and there
- Jorjani and Ibn Sina advanced the knowledge of is inability to close the eye completely. Due to
Razi‟s al-Hawi was first translated into Latin in inability to close eyes completely there is dry eye
1279, coming into print in Europe in 1468. or excessive tearing of the eye.
- Ibn Sina‟s Canon, which was more systematic and  There is drooping of corner of the mouth.
understandable than al-Hawi, was the main textbook  Ipsilateral impaired/loss of taste sensation.
in many medical schools between the 14th and 16th  On the affected side of the mouth, there is difficulty
centuries, and thus those physicians should have with eating due to the ipsilateral muscle weakness
been exposed to Razi‟s ideas. causing food to be trapped on, dribbling of saliva.
- Douglas ,Friedreich and Thomassen a thuessink also  On the affected side of the face there is altered
described it. sensation, pain in or behind the ear. On affected side
- In 1821, Sir Charles Bell described the anatomy of there is increased sensitivity to sound (hyperacusis)
the facial nerve and its association with the , if stapedius muscle involved.3

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-They could not perform tapping movement of mandible

PROSTHODONTIC SIGNIFICANCE when instructed. Rajapur., et al. (2015) recommend a
1
Objectives of prosthetic rehabilitation systematic stepwise approach for the rehabilitation of
1. To support weakened facial musculature. edentulous patient started by fabrication of interim
2. So as to decrease the amount of surgical procedures dentures for neuromuscular training predictable
in case patient refused to have another surgery. mandibular movement before the fabrication of final
3. To provide mainly comfort and esthetics to the dentures.
patient with improved confidence and due to Rajapur., et al. used “Lingualized Occlusion” as
positive esthetic changes improve social previous studies have shown that it has better
interactions. masticatory efficiency and prevented lateral movements
In bells palsy patients ,there are many symptoms that of dentures. After complete denture processed,
jeopardize prosthodontic treatment . Cheek biting, remounted laboratory and occlusal interferences were
uncontrolled flow of saliva, having mask like eliminated. The posterior teeth on both sides of
expressionless appearance, unpredictable and erratic mandibular denture were removed and flat occlusal
mandibular movement are few symptoms . During tables were made using self-cure clear acrylic resin. The
impression taking, jaw relation and other procedures,they flat occlusal table used to analyze the occlusion and also
may interfere. to perform the tapping movement. Before complete
curing of the resin, ensuring even contacts of all the
1
-Face lift device palatal cusps on the mandibular occlusal flat tableThis is
It is a removable partial prosthesis which is used for an effective method for rehabilitation of Bell‟s palsy
patient with facial paralysis so as to support affected patient who has very irregular and erratic mandibular
side muscles of the face during regeneration . Aesthetics movements.
and functions of patients face is restored with this device.
Dr. Syed Kazmi used this device in 2013 to treat a Modified complete denture1
patient with facial nerve paralysis with problem in -Denture with un detachable buccal plumper
phonetics and compromised aesthetics as well as This way can be obtained simply by adding wax to the
mastication. labial and buccal flange of maxillary complete denture in
the try in visit step. The additional material could be
1
-Edentulous Bell’s palsy patients easily added. Amount of adding wax and its direction
In addition to previously mentioned signs and symptoms managed by dentist until reaching a satisfied result in
of Bell‟s palsy, edentulous patient could suffer from:- A terms of esthetic and speech improvement. Then
very clear mandibular shift toward the non-affected side complete processing of denture using heat cure acrylic
along with significant difficulty in pronunciation of resin is carried out. After dentures insertion, proper post
bilabial (p,b), labiodental and fricatives (f,v) and had a insertion instruction should be given to patient with
slurred speech. further inforce to oral hygiene to avoid food entrapment
between the dentures and the cheeks.

Journal Of Applied Dental and Medical Sciences 4(4);2018

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support teeth during actual use,This design will act as a

1
-Denture with extended buccal flange -This way of reliner for the denture and thus has an advantage over
denture modification discussed by Godavarthi and his existing design.When no forces are applied,foil remains
colleagues in 2012 for management of completely in resting position act as a soft reliner and when denture
edentulous patient with Bell‟s palsy. is in use vertical forces are distributed in all directions by
the liquid resulting in optimal stress distribution.This
-Denture with detachable buccal or cheek plumper 1
helps in long term preservation of bone and tissues5.
Also known as “cheek lifting appliance” According to
Kamakshi and his colleagues , this cheek plumper was - Neutral Zone Philosophy is based on concept that for
demonstrated during try in visit by placing wax in the each individual patient there exists within the denture
premolar and first molar region. The waxed cheek space a specific area where function of musculature will
plumper was superficially attached to the maxillary not unseat denture and force generated by tongue is
denture buccal flanges, in the affected(paralyzed) side. neutralized by lip and cheeks6.
Plumper designed according to the available space -Facial palsy is indicative of neurological involvement.
intraorally necessary to enhance the appearance and Patients with this disease can be treated but it is essential
supporting the sunken cheeks with proper thickness. This that they understand their problems. Denture retention,
would not interfere with functional movement. After maxillomandibular relation records and supporting the
satisfactory denture try in, denture with cheek plumper musculature are some of the added denture problems..
was fabricated separately with a heat cure acrylic resin, Use of non anatomic posterior teeth minimizes the
then male and female parts of attachment (press button, damage to the denture supporting tissues7.
magnets, wires and buccal tube, were imbedded in
denture buccal flange out surface and plumper in surface CONCLUSION
with using self-cure acrylic resin then finishing and The ultimate treatment for any unrecovered facial
polishing were carried out. paralysis will be a surgical intervention of the damaged
nerve. When most of the cases are abandoned from
-Using of magnet attachment in detachable buccal or surgery due to complications and other reasons, the oral
1
cheek plumper prosthesis plays an important role in patient's well-being.
Magnets are one of the common attachments utilized in The goal of the prosthetic treatment should be to support
dentistry and specially with the detachable cheek the weakened muscles and provide comfort and esthetics
plumper to the patient over a long period of time.

-Liquid Supported Complete Denture in maxilla REFERENCES

edentulous area and neutral zone technique in 1. Bukhari MA, Jambi SM. Prosthodontic
mandibular edentulous arch is also very beneficial.The Rehabilitation of Completely Edentulous and
principle of this design is that liquid denture adapts Partially Edentulous Patients with Bell‟s Palsy.EC
continuously with mucosa.However it is also rigid to Dental science. 2018; 17(6):810-19.

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2. Sajadi MM, Sajadi MR, Tabatabaie SM. The history

of facial palsy and spasm: Hippocrates to
Razi. Neurology. 2011; 77(2):174–8.
3. Somasundara D, Sullivan F, Chees. Management of
Bell‟s palsy. Aust Prer. 2017; 40(3):94-97.
4. Klobucar R, Kingsmill V, Venables V. A dental
perspective of facial palsy. Facu Dent J 2012;
3(4):203-207.
5. Makkar R, Choukse V. Prosthodontic Management
of Completely Edentulous Patient with Unilateral
Facial Paralysis.J Oral Healt Dent. 2018; 12(1):31-
36.
6. Rathi A, Mathema SRB. Prosthodontic Management
of Edentulous Patient with Bells Palsy Utilizing
Neutral Zone-A Case Report. Oral H and Dent.
2007; 1(6):277-282.
7. Pandey S, Datta K. Prosthodontic Management of a
Completely Edentulous patient with Unilateral
Facial Paralysis. J Ind PS. 2007; 7:211-213.

Journal Of Applied Dental and Medical Sciences 4(4);2018