Facial Palsy
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Clinically Relevant Anatomy
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The VIIth cranial Nerve has its nucleus in the Pons, and takes a rather winding route before exiting the skull through the stylomastoid foramen.
Mechanism of Injury / Pathological Process
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Causes of Facial Palsy:
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- Idiopathic
Bell's Palsy - cause not known [1] but possibly linked to Herpes Simplex infection [2]
Ramsay Hunt Syndrome - linkied to Herpes Zoster infection [3]
- Tumour
A tumor compressing the facial nerve can result in facial paralysis, but more commonly the facial nerve is damaged during surgical removal of a tumour. The most common tumour to result in facial palsy during surgical removal is the Acoustic Neuroma (AKA Vestibular Schwannoma). Less commonly, cholesteatoma, hemangioma, Facial Neuroma or partotid gland tumours are the cause.
- Lyme Disease
Infection with Borrelia burgdorferi via tick bites is another cause of facial paralysis. Of patients affected with Lyme disease, 10% develop facial paralysis, with 25% of these patients presenting with bilateral palsy.[5]
- Rare causes include
Neurosarcoidosis, ototis media, Multiple Sclerosis, Moebius Syndrome
- Trauma, especially temporal bone fractures
Clinical Presentation[edit | edit source]
Paralysis of the muscles supplied by the Facial Nerve presents on the affected side of the face as follows:
Appearance and range of movement:[edit | edit source]
Inability to close the eye
Inability to move the lips eg. into smile, pucker
At rest, the affected side of the face may "droop"
Functional effects:[edit | edit source]
Difficulty eating and drinking as lack of lip seal makes it difficult to keep fluids and food in the oral cavity
Reduced clarity of speech as the "labial consonents" (ie. b, p, m, v, f) all require lip seal
Somatic effects:[edit | edit source]
The facial nerve supplies the lachrymal glands of the eye, the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the anterior 2/3 of the tongue. Facial palsy often involves:
Lack of tear production in the affected eye, causing a dry, possibly painful eye, with risk of corneal ulceration
Hyperacusis = sensitivity to sudden loud noises
Altered taste sensation
Differential Diagnosis, UMN versus LMN:[edit | edit source]
If the forehead is not affected (ie the patient is able to raise fully the eyebrow on the affected side) then the facial palsy is likely to be a result of a lesion in the Upper Motor Neuron (UMN). Paralysis which includes the forehead, such that the patient is unable to raise the affected eyebrow, is a Lower Motor Neuron (LMN)lesion.
Diagnostic Procedures[edit | edit source]
Laboratory investigations include an audiogram, nerve conduction studies (ENoG), computed tomography (CT) or magnetic resonance imaging (MRI), electromyography (EMG).
Outcome Measures[edit | edit source]
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Management / Interventions
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Key Evidence[edit | edit source]
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Resources
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References[edit | edit source]
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- ↑ Peiterson,E. Bell's Palsy; the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto-Laryngologica. Supplementum 2002;549:4-30
- ↑ Holland NJ, Weiner GM. Recent developments in Bell's Palsy. BMJ 2004; 329(7465):553-7
- ↑ Hunt JR. On herpetiform inflammation of the geniculate ganglion: A new syndrome and its complications. Nerve Ment Dis. 1907;34:73.