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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: 
Vata gets aggravated 
Localised in 
head,nose,lips,chin,forehead,eyes 
Causes sankocha of organs&produces 
pain and causes ardita vata.
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 
Ardita 
vata 
Ardita Ekayama
 According to charaka 2 types 
Ardita vata 
Ardita 
Visista 
ardanga 
vata
 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 recieves 
bilateral 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 orbicularis 
oculi. 
 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 fascial 
expressions(grafting of muscles from thigh to 
corners of mouth).
DIFFERENCE BETWEEN 
FACIAL PALSY&BELL’S 
PALSY 
FACIAL 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,endoscopic 
brow lift. 
 Eye lid weight placement – occuloplastic 
management 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 alar 
base to temporalis facia to open extra nasal valve. 
 Cross Face Nerve Transplant(CFNT) – It is most 
advanced. 
 It is making continuity between paralysed&normal 
facial 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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Ardita vata..a brief ppt

  • 2. INDEX:  Definition-Ardita vata  Introduction  Nidanam  Samprapti  Poorva rupa  Rupa  Types  Treatment
  • 3. 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.
  • 4. 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.
  • 5. NIDANA:  Carrying heavy weights on head  Excessive yawning,laughing  Pregnant woman  Shouting loudly  Eating hard foods  Old persons  Children  Fear  Grief
  • 6. SAMPRAPTI: Vata gets aggravated Localised in head,nose,lips,chin,forehead,eyes Causes sankocha of organs&produces pain and causes ardita vata.
  • 7. POORVA RUPA:  Horripulations  Tremors  Belching  Loss of sensation&pain in skin  Catching pain in shoulders
  • 8. 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
  • 9. TYPES:  According to vagbhata 2 types Ardita vata Ardita Ekayama
  • 10.  According to charaka 2 types Ardita vata Ardita Visista ardanga vata
  • 11.  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.
  • 12. 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
  • 13. 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
  • 14.  According to vagbhata - 1)nasya - 2)karna poorana - 3)akshi tarpana - 4)emesis - 5)venesection  According to bhavamishra Ksheera prepared with DMQ or BMQ
  • 16. 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
  • 17. SUPRA NUCLEAR &INFRA NUCLEAR LESIONS:  The facial motor nucleus have two divisions. 1)dorsal division 2)ventral division  Dorsal division contains UMN’S which recieves bilateral input from brain.  Ventral division contains LMN’S which receives only contra lateral input.
  • 18. FACIAL NERVE AND ITS SUPPLY TO THE MUSCLES:
  • 19. BRANCHES OF FACIAL NERVE:  Temporal branch – supplies to frontalis &orbicularis oculi.  Zygomatic branch – supplies to orbicularis oculi.  Buccal branch – supplies to upper lip &cheek.  Mandibular branch – supplies to lower lip.  Cervical branch – supplies to neck muscles.
  • 20. SYMPTOMS:  Unilateral facial weakness.  Loss of taste.  Hyperacusis-A heightened sensitivity to some sounds.  Decreased salivation & tear secretion.
  • 21. 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
  • 22. 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.
  • 23. 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.
  • 25. CAUSES:  Infection  Trauma  Tumour  Other causes
  • 26. 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)
  • 27.  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).
  • 28.  Facial nerve and its relation with the middle ear
  • 29. 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
  • 30. CONGENITAL FACIAL PALSY:  It is mainly due to application of foreceps during delivery.
  • 31. 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
  • 32. BELL’S PALSY DUE TO COMPRESSION:
  • 33. OTHER CAUSES: 1)Diabetes milletes 2)Nervus sarcoidosis 3)Moebius syndrome 4)Guillaine –barre syndrome 5)pregnancy
  • 34.  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.
  • 35.  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 fascial expressions(grafting of muscles from thigh to corners of mouth).
  • 36. DIFFERENCE BETWEEN FACIAL PALSY&BELL’S PALSY FACIAL 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.
  • 37. 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.
  • 39. TREATMENT:  Brow ptosis correction – direct brow lift,endoscopic brow lift.  Eye lid weight placement – occuloplastic management 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 alar base to temporalis facia to open extra nasal valve.  Cross Face Nerve Transplant(CFNT) – It is most advanced.  It is making continuity between paralysed&normal facial nerves by means of bridge grafts.
  • 41. EYE LID WEIGHT PLACEMENT:
  • 43. CROSS FACE NERVE TRANSPLANT(CFNT):