By N. Jagadish

INDEX:

Definition-Ardita vata

Introduction

Nidanam

Samprapti

Poorva rupa

Rupa

Types

Treatment

DEFINITION:

It is a disease in which there is a

deviation leading to deformity of one

side of face alone or along with half side

of the body.

INTRODUCTION:

Acc to Charaka & Vagbhata ardita vata

is included in the group of Vataja

Nanatmaja Vyadhis.

Acc to Charaka he also included the

same ardita vata under Samanya siro

rogas.

NIDANA:

Carrying heavy weights on head

Excessive yawning,laughing

Pregnant woman

Shouting loudly

Eating hard foods

Old persons

Children

Fear

Grief

SAMPRAPTI:

Causes sankocha of organs&producespain and causes ardita vata.

Localised in head,nose,lips,chin,forehead,eyes

Vata gets aggravated

POORVA RUPA:

Horripulations

Tremors

Belching

Loss of sensation&pain in skin

Catching pain in shoulders

RUPA:

Absence of nasolabial fold on affected

side

Absence of wrinkles on head

Drooping of eyelid

Deviation of mouth to healthy side

Difficult in chewing

Slurred speech

Tremors of neck

TYPES:

According to vagbhata 2 types

Arditavata

Ardita Ekayama

According to charaka 2 types

Ardita vata

ArditaVisista

ardangavata

According to bhavamisra and

yogaratnakara 3 types based on dosas

1)vata ardita -pain,excessive

salivation,oedema of lips.

2)pitta ardita - trsna,jwara,daha.

3)kapha ardita - oedema in

neck&stiffness.

ASADYA LAKSHANAS:

According to susruta

1)ksheena-weak person

2)Inability to close eyes

3)Disturbed or slurred speech

4)Excessive nasal secretions

5)Excesive tear drops

6)excessive oral secretions

TREATMENT:

According to charaka& Susrutha.

1)nasya - shadbindu taila or anutaila

2)nadi swedana

3)upanaha - meat of animals of marshy lands(anoopa prani)

4)moordha taila - application of oil on head as

• Pichu

• Sirovasti

• Sirodhara with ksheera bala or nirgundi taila

According to vagbhata

- 1)nasya

- 2)karna poorana

- 3)akshi tarpana

- 4)emesis

- 5)venesection

According to bhavamishra

Ksheera prepared with DMQ or BMQ

FACIAL

PALSY

DEFINITION:

Paralysis of any structures innervated by

facial nerve is known as facial palsy.

Facial paralysis

Supra nuclear lesions

Caused due to lacunar infarct affecting fibres

in internal capsule

Infra nuclear lesions

Majority of causes of facial palsy is due to

this lesions

SUPRA NUCLEAR &INFRA

NUCLEAR LESIONS: The facial motor

nucleus have two divisions.

1)dorsal division

2)ventral division

Dorsal division contains UMN’S which recievesbilateral input from brain.

Ventral division contains LMN’S which receives only contra lateral input.

FACIAL NERVE AND ITS

SUPPLY TO THE MUSCLES:

BRANCHES OF FACIAL

NERVE: Temporal branch –

supplies to frontalis&orbicularis oculi.

Zygomatic branch –supplies to orbicularisoculi.

Buccal branch –supplies to upper lip &cheek.

Mandibular branch –supplies to lower lip.

Cervical branch –supplies to neck muscles.

SYMPTOMS:

Unilateral facial weakness.

Loss of taste.

Hyperacusis-A heightened sensitivity to

some sounds.

Decreased salivation & tear secretion.

TYPES OF FACIAL PALSY:

Different types of facial palsy according to

the point at which the nerve is affected.

1)lesion in pons - taste&hearing not effected

2)Lesion in petrous bone – palsy of facial

muscles+loss of taste

3)Lesion in chorda tympani – no salivary

secretions

4)Lesion in stonpedius – sense of hearing is

loss

Difference between UMN&LMN

Lesions

UMN LESIONS LMN LESIONS

Only lower 2/3 rd of the

facial muscles are

affected.

Mid face is paralysed.

Eye brow’s can move

normally.

Totally half side of the is

affected.

Half of the Mid face is

only paralysed.

Eye brow’s can’t move

normally.

BELL’S PALSY:

It is the commonest type of facial palsy.

It is the major cause of the acute facial nerve paralysis.

It affects totally half side of the face due to the LMN Lesion.

Here the palsy is due to the inflammation of the facial nerve.

The inflammation prevents nerve from sending correct signals to brain &facial muscles.

SYMPTOMS:

CAUSES:

Infection

Trauma

Tumour

Other causes

INFECTION:

Herpes zoster virus - reactivation of virus within dorsal root ganglion of facial nerve is assosiated with vesicles affecting ear canal.

Symptoms -1)ear pain

2)vesicles

3)hearing loss

4)vertigo

o Treatment –1)anti viral

2)steroids(corticosteroids)

Otitis media –inflammation of the middle

ear due to infections can spread to facial

nerve &inflame it causing compression.

Symptoms -1)ottorrhoea(discharge).

2)otalgia(no ear pain).

Treatment –myringotomy(incision to

tympanic membrane).

Facial nerve and its relation with the

middle ear

TRAUMA:

1)fractures of temporal bone due to

injury in accidents.

2)birth injury to the facial nerve at the

time of delivery due to application of fore

ceps.

reason :it remains unprotected after

its exit through stylomastoid foramen.

investigation –CT Scan

CONGENITAL FACIAL

PALSY: It is mainly due to application of

foreceps during delivery.

TUMOUR:

The bells palsy may be due to tumour’s

which compress the the nerve along its

course.

investigation -1)Tomography.

2)MRI(to locate tumour)

3)CT Scan

BELL’S PALSY DUE TO

COMPRESSION:

OTHER CAUSES:

1)Diabetes milletes

2)Nervus sarcoidosis

3)Moebius syndrome

4)Guillaine –barre syndrome

5)pregnancy

Diabetes milletus –the person with DM is more susceptible for otitis inflammation.

Sarcoidosis –abnormal collections of inflammatory cells which transform as nodules is known as sarcoidosis.As it occurs in facial nerve it is known as nervus sarcoidosis.

investigations –angiotensin converting enzyme levels.

treatment -1) Ibuprofen or aspirin.

2)if it progress-prednisolone.

Moebius syndrome –This can be taken as congenital malformity.

under development of 7th&6th cranial nerves is known as moebius syndrome.

symptoms -1)cannot close eye.

2)no facial expression.

3)complete facial palsy.

treatment -1)tarsorraphy-(eye).

2)smile surgery-for fascialexpressions(grafting of muscles from thigh to corners of mouth).

DIFFERENCE BETWEEN

FACIAL PALSY&BELL’S

PALSYFACIAL PALSY BELL’S PALSY

1)Cause can be known

(infection,trauma,

tumour).

2)Permanent(lasts for

years to life).

3)need surgical

treatment.

4)Site of affection

depends upon

UMN&LMN Lesions.

1)It is idiopathic(may de

velop suddenly).

2)Temporary(permanent

cure with in 3 months in

90% of cases).

3)Without treatment or

surgery regains facial

function.

4)It is mainly due to

LMN Lesions.half side

of the face is totally

affected.

Tests for facial palsy:

Ask the patient to show his teeth.

Ask the patient to puff his cheeks.

Ask the patient to close his eyes against

resistance.

Ask the patient to lift his eyebrows.

TESTS:

TREATMENT:

Brow ptosis correction – direct brow lift,endoscopicbrow lift.

Eye lid weight placement – occuloplasticmanagement for lagopthalmus.

Static facial suspension – by using facial slings from zygomatic/temporalis arch to nasolabial fold & oral commisure.

Extra nasal valve repair – facia lata sling from alarbase to temporalis facia to open extra nasal valve.

Cross Face Nerve Transplant(CFNT) – It is most advanced.

It is making continuity between paralysed&normalfacial nerves by means of bridge grafts.

BROW PTOSIS

CORRECTION:

EYE LID WEIGHT

PLACEMENT:

STATIC FACIAL

SUSPENSION:

CROSS FACE NERVE

TRANSPLANT(CFNT):