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    Managing A Patient Having Bell's Palsy in Prosthodontics

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    Sara Sajjad
    1. Bell's palsy causes paralysis of the facial nerve, resulting in drooping of the face on the affected side and impacting muscles involved in denture stability. 2. When treating a patient with Bell's palsy, it is important to record the neutral zone to account for imbalanced forces from the affected and unaffected sides of the face. 3. Additional material should be added to the denture on the affected side of the face to reduce drooping and improve stability.

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    Managing A Patient Having Bell's Palsy in Prosthodontics

    Uploaded by

    Sara Sajjad
    2K views12 pages
    1. Bell's palsy causes paralysis of the facial nerve, resulting in drooping of the face on the affected side and impacting muscles involved in denture stability. 2. When treating a patient with Bell's palsy, it is important to record the neutral zone to account for imbalanced forces from the affected and unaffected sides of the face. 3. Additional material should be added to the denture on the affected side of the face to reduce drooping and improve stability.

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    Managing a Patient Having Bell's Palsy in Prosthodontics

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    1. Bell's palsy causes paralysis of the facial nerve, resulting in drooping of the face on the affected side and impacting muscles involved in denture stability. 2. When treating a patient with Bell's palsy, it is important to record the neutral zone to account for imbalanced forces from the affected and unaffected sides of the face. 3. Additional material should be added to the denture on the affected side of the face to reduce drooping and improve stability.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    2K views12 pages

    Managing A Patient Having Bell's Palsy in Prosthodontics

    Uploaded by

    Sara Sajjad
    1. Bell's palsy causes paralysis of the facial nerve, resulting in drooping of the face on the affected side and impacting muscles involved in denture stability. 2. When treating a patient with Bell's palsy, it is important to record the neutral zone to account for imbalanced forces from the affected and unaffected sides of the face. 3. Additional material should be added to the denture on the affected side of the face to reduce drooping and improve stability.

    Copyright:

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    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 12

    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 y
    y y y 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
    y y y 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
    y y y y y y y 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


    y y y y y y y y y 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:


    y y y y y y y y Occipitofrontalis Procerus Nasalis muscle Depressor septinasi Orbicularis oculi Corrugator supercilii Depressor supercilii Auricular muscles (anterior, superior, posterior)

    Facial muscles that affect denture stability


    y y y y y Buccinator Orbicularis oris Levatorangulioris Depressor angulioris Mentalis

    BUCCINATOR MUSCLE:
    Importance in recording
    Maxilla: y y Buccalfrenum Buccal vestibule

    Mandible: y y y y Buccalfrenum Buccal vestibule Retromylohyoid fossa Retromolar pad

    ORBICULAROUS ORIS:
    Importance in recording
    Maxilla: y y Labial vestibule Buccalfrenum

    Mandible: y Labial frenum

    LEVATOR ANGULI ORIS:


    Importance in recording
    Maxilla: y Buccalfrenum

    Mandible: y No any

    DEPRESSOR ANGULI ORIS:


    Importance in recording
    Maxilla: y No any

    Mandible: y Buccalfrenum

    MENTALIS:
    Importance in recording
    Maxilla: y No any

    Mandible: y 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
    y y y 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??


    y y y y 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


    y 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


    y A stable denture base is constructed on master cast

    Recording Neutral Zone


    y 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

    Ma n d ibu la r re c o rd ba se with mo d e lin g pla stic impre ssio n c o mpo u n d mo u ld e d to pa tie n ts n e u tra l z o n e

    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
    y y 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


    y y 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
    y y Dentures are processed and inserted Pateint's satisfaction

    Instructions
    Patient is educated about oral and denture hygiene maintenance

    References
    y y y y y 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 VipulAsopa) Pictures from e-net and books

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