managing a patient having bell's palsy in prosthodontics
TRANSCRIPT
Presentation:
Scenario:
A patient has been suffering from bell's palsy on the right side for the last one year visits your clinic as he wants a denture. How this condition would affect your treatment protocol??
By :
Sara Sajjad
Final Year B.D.S
Department of Prosthodontics
SBDC Gandhara University
What is BELL'S PALSY??
Named after CHARLES BELL
(Well known for his studies on the nervous system and the brain)
In the 19th century he discovered that lesions of the 7th cranial nerve i.e the facial nerve cause facial paralysis.
Types:
A). Temporary
Most common Lasts for weeks to months only Recovers but can reoccur Causes includes:
viral infections, ear infections, high B.P. Diabetes, headaches, trauma etc.
B). Permanent
Less common Considered when lasts for more than 9 months Causes includes
birth trauma, major damage to the nerve due to trauma, laceration etc.
Clinical features
Facial asymmetry Eyebrow droop Inability to close eye Uncontrolled tearing Drooping of corner of mouth Loss of forehead & nasolabial
folds Lips not held tightly together:
Difficulty keeping food in mouth
Difficulty in keeping food on occlusal table
Other signs and symptoms
Pain or discomfort in jaw Headache Dizziness Dryness of eyes Loss of taste Dryness of mouth and Impaired speech Difficulty in eating and drinking Ringing in the ear Hypersensitivity to sound
The facial muscles which are affected include:
Occipitofrontalis Procerus Nasalis muscle Depressor septi nasi Orbicularis oculi Corrugator supercilii Depressor supercilii Auricular muscles (anterior, superior, posterior)
Facial muscles that affect denture stability
Buccinator Orbicularis oris Levator anguli oris Depressor anguli oris Mentalis
BUCCINATOR MUSCLE:
Importance in recording
Maxilla:
Buccal frenum Buccal vestibule
Mandible:
Buccal frenum Buccal vestibule Retromylohyoid fossa Retromolar pad
ORBICULAROUS ORIS:
Importance in recording
Maxilla:
Labial vestibule Buccal frenum
Mandible:
Labial frenum
LEVATOR ANGULI ORIS:
Importance in recording
Maxilla:
Buccal frenum
Mandible:
No any
DEPRESSOR ANGULI ORIS:
Importance in recording
Maxilla:
No any
Mandible:
Buccal frenum
MENTALIS:
Importance in recording
Maxilla:
No any
Mandible:
Labial frenum
Central VS Peripheral Facial Nerve Palsy
Facial paralysis is due to a lesion of the facial motor nucleus or of the nerve
A lower motor neuron lesion:
All the muscles of the same side of the face are affected. (There may also be inadequate lacrimal or salivary secretion, or a localized taste deficit, depending on the exact location of the lesion.)
An upper motor neuron lesion:
Affects only the lower half of the contra-lateral side of the face
Important Note
Neuro-muscular function and coordination are foundation for successful and stable dentures Failure to diagnose importance of flange contour and teeth position in facial paralysis patients
often leads to unstable dentures In unilateral facial paralysis patient, it is essential to record neutral zone because of imbalanced
forces generated by unaffected and affected side causing instability in dentures
What is neutral zone??
Also known as “zone of minimal conflict” or “Dead Space” The zone where the cheeks, lips and tongue are in maximal harmony with the dentures That is the teeth in the denture must occupy the same position as there natural predecessors The inward forces by the lips and cheeks should be balanced by the outward forces by the
tongue
Initial & Final Impression Recording
Conventional technique for making primary and final impressions is followed except that excessive material is incorporated on the right side that is the affected side
Temporary Denture Base
A stable denture base is constructed on master cast
Recording Neutral Zone
After initial adjustment of occusal plane according to aesthetics and phonetics, compound rim was softened and patient was encouraged to do functional movements such as swallowing, sucking, pursing lips
Thus the polished surface of denture base was contoured by functions of the tongue and action and tonus of affected and unaffected lips and cheek
Recording Neutral zone Mandibular record base with modeling plastic impression compound moulded to patient’s neutral zone
A plaster index was fabricated to duplicate
the contour of polished surface in trial denture
Occlusal wax Rims
Midline placed in the middle of the oral cavity rather than the facial midline
Teeth Set-up
Teeth are arranged according to the neutral zone matrix Non anatomic posterior teeth are used to establish the centric occlusion
Some improvement of the appearance can be achieved by:
1. Placing the mesio-incisal point in the middle of the mouth rather than the middle of the face
2. keep the cant of the occlusal plane on the right side a little low for incisal show
Buccal sulcus support
Placing buccal support on the right side to reduce the facial droop This will also help reduce the accumulation of food in the affected buccal vestibule
Finally
Dentures are processed and inserted Pateint's satisfaction
Instructions
Patient is educated about oral and denture hygiene maintenance
References
Designing Full Dentures by Watt and MacGregor Prosthodontic treatment of edentulous patients by Zarb-Bolender Jaypee text book of Prosthodontics by Nallaswamy Prosthodontic management of complete edentulous patients with neuromuscular disorders -
Case reports (Suresh S Vipul Asopa) Pictures from e-net and books