N91 Facial paralysis/bell’s palsy (ICD-10:G51.0)

Introduction

Facial paralysis, also known as Bell’s palsy, is a condition characterized by the sudden weakness or paralysis of the muscles on one side of the face^[1]. This condition can be caused by various factors, including viral infections, nerve inflammation, or trauma^[2]. The aim of this guide is to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for facial paralysis/Bell’s palsy

Codes

• ICPC-2 Code: N91 Facial paralysis/bell’s palsy
• ICD-10 Code: G51.0 Bell palsy

Symptoms

• Sudden weakness or paralysis on one side of the face^[3]
• Drooping of the mouth or eyelid on one side^[4]
• Difficulty closing one eye or blinking^[5]
• Loss of the sense of taste on the front two-thirds of the tongue^[6]
• Increased sensitivity to sound in one ear^[7]
• Pain or discomfort around the jaw or behind the ear on the affected side^[8]

Causes

• Viral infections, such as herpes simplex virus or Epstein-Barr virus^[9]
• Nerve inflammation, often due to viral infections^[10]
• Trauma or injury to the facial nerve
• Autoimmune diseases, such as multiple sclerosis or Guillain-Barré syndrome
• Tumors or growths pressing on the facial nerve

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the onset, duration, and progression of facial weakness or paralysis
• Ask about any recent viral infections or exposure to potential triggers
• Inquire about any history of trauma or injury to the face or head
• Assess for any underlying medical conditions or autoimmune diseases

Physical Examination

• Observe the patient’s facial symmetry at rest and during various facial movements
• Assess the patient’s ability to close their eyes tightly and raise their eyebrows
• Test the patient’s sense of taste on the front two-thirds of the tongue
• Check for any signs of pain or discomfort around the jaw or behind the ear on the affected side

Laboratory Tests

• Blood tests: To check for signs of infection or autoimmune diseases
• Polymerase chain reaction (PCR) test: To detect the presence of viral DNA or RNA
• Electromyography (EMG): To assess the electrical activity of the facial muscles
• Lumbar puncture: To analyze the cerebrospinal fluid for signs of infection or inflammation

Diagnostic Imaging

• Magnetic resonance imaging (MRI): To visualize the facial nerve and rule out any tumors or growths
• Computed tomography (CT) scan: To assess the bony structures of the face and rule out any fractures or abnormalities
• Ultrasound: To evaluate the blood flow in the facial arteries and veins

Other Tests

• Eye examination: To assess the patient’s ability to close their eyes completely and protect the cornea
• Audiometry: To evaluate the patient’s hearing and assess for any changes in sensitivity to sound
• Salivary flow test: To measure the production and flow of saliva on the affected side

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the progress of facial paralysis and assess for any complications
• Provide education on facial exercises and techniques to improve muscle strength and coordination
• Discuss the importance of protecting the affected eye and maintaining good oral hygiene
• Address any concerns or questions the patient may have regarding their condition

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Facial paralysis/Bell’s palsy:

1. Corticosteroids (e.g., Prednisone):
   • Cost: Generic versions can be $3-$50/month.
   • Contraindications: Active infections, uncontrolled diabetes.
   • Side effects: Increased appetite, weight gain, mood changes.
   • Severe side effects: Increased risk of infections, adrenal suppression.
   • Drug interactions: Nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants.
   • Warning: Gradual tapering of the medication is necessary to avoid adrenal insufficiency.
2. Antiviral medications (e.g., Acyclovir, Valacyclovir):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Allergy to the medication, renal impairment.
   • Side effects: Nausea, vomiting, headache.
   • Severe side effects: Severe allergic reactions, kidney damage.
   • Drug interactions: Probenecid, nephrotoxic drugs.
   • Warning: Adequate hydration is important to prevent kidney damage.
3. Analgesics (e.g., Acetaminophen, Ibuprofen):
   • Cost: Generic versions can be $3-$10/month.
   • Contraindications: Allergy to the medication, active gastrointestinal bleeding.
   • Side effects: Upset stomach, dizziness.
   • Severe side effects: Liver damage, gastrointestinal bleeding.
   • Drug interactions: Warfarin, other nonsteroidal anti-inflammatory drugs (NSAIDs).
   • Warning: Avoid exceeding the recommended dosage to prevent liver damage.
4. Eye lubricants (e.g., Artificial tears):
   • Cost: $5-$20 per bottle.
   • Contraindications: Allergy to the medication.
   • Side effects: Temporary blurred vision.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Use as directed to prevent eye dryness and protect the cornea.
5. Muscle relaxants (e.g., Baclofen, Tizanidine):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Allergy to the medication, liver impairment.
   • Side effects: Drowsiness, dizziness.
   • Severe side effects: Severe allergic reactions, liver toxicity.
   • Drug interactions: Sedatives, alcohol.
   • Warning: Avoid activities requiring mental alertness while taking the medication.

Alternative Drugs:

• Alpha-lipoic acid: An antioxidant that may help reduce inflammation and promote nerve regeneration.
• Vitamin B12: May help improve nerve function and reduce symptoms of facial paralysis.
• Magnesium: May help relax muscles and reduce muscle spasms.
• Coenzyme Q10: May have antioxidant properties and support nerve health.
• Hypericum perforatum (St. John’s wort): May have anti-inflammatory and antidepressant effects.

Surgical Procedures:

• Surgical decompression of the facial nerve: In cases of severe or prolonged facial paralysis, surgical decompression of the facial nerve may be considered to relieve pressure and improve nerve function. Cost: $5,000 to $15,000.

Alternative Interventions

• Acupuncture: May help improve blood flow and reduce pain. Cost: $60-$120 per session.
• Physical therapy: Exercises and techniques to improve muscle strength and coordination. Cost: $50-$150 per session.
• Transcutaneous electrical nerve stimulation (TENS): Application of low-voltage electrical currents to the facial muscles to stimulate nerve function. Cost: $50-$100 per session.
• Herbal supplements: Some herbs, such as ginkgo biloba and turmeric, may have potential benefits for reducing inflammation and promoting nerve health. Cost: Varies depending on the specific supplement.
• Mind-body techniques: Stress reduction techniques, such as meditation or yoga, may help improve overall well-being and support the body’s healing process. Cost: Varies depending on the specific technique or class.

Lifestyle Interventions

• Protect the affected eye: Use eye patches or goggles during sleep to prevent corneal damage.
• Maintain good oral hygiene: Brush and floss regularly to prevent dental problems and maintain oral health.
• Practice facial exercises: Regularly perform facial exercises to improve muscle strength and coordination.
• Manage stress: Engage in stress-reducing activities, such as meditation or deep breathing exercises.
• Get enough rest: Ensure an adequate amount of sleep to support the body’s healing process.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – N91 Facial paralysis/bell’s palsy (ICD-10:G51.0)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Facial paralysis/bell’s palsy effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Facial paralysis/bell’s palsy. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;(549):4-30. doi:10.1080/000164802760370736
2. Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell’s palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry. 2015;86(12):1356-1361. doi:10.1136/jnnp-2014-309563
3. Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell’s palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-S27. doi:10.1177/0194599813505967
4. Holland NJ, Weiner GM. Recent developments in Bell’s palsy. BMJ. 2004;329(7465):553-557. doi:10.1136/bmj.329.7465.553
5. Tiemstra JD, Khatkhate N. Bell’s palsy: diagnosis and management. Am Fam Physician. 2007;76(7):997-1002.
6. Adour KK, Byl FM, Hilsinger RL Jr, Kahn ZM, Sheldon MI. The true nature of Bell’s palsy: analysis of 1,000 consecutive patients. Laryngoscope. 1978;88(5):787-801. doi:10.1002/lary.1978.88.5.787
7. Yeo SW, Lee DH, Jun BC, Chang KH, Park YS. Analysis of prognostic factors in Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx. 2007;34(2):159-164. doi:10.1016/j.anl.2006.09.005
8. Peitersen E. The natural history of Bell’s palsy. Am J Otol. 1982;4(2):107-111.
9. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 1996;124(1 Pt 1):27-30. doi:10.7326/0003-4819-124-1_part_1-199601010-00005
10. Linder T, Bossart W, Bodmer D. Bell’s palsy and Herpes simplex virus: fact or mystery?. Otol Neurotol. 2005;26(1):109-113. doi:10.1097/00129492-200501000-00020