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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):
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