Facial nerve paralysis

Jump to navigation Jump to search

For patient information click here

Facial nerve paralysis
Moche. Culture Representation of Facial Paralysis. 300 A.D. Larco Museum Collection, Lima, Peru.
ICD-9 351
eMedicine plastic/522 
MeSH D005158

WikiDoc Resources for Facial nerve paralysis

Articles

Most recent articles on Facial nerve paralysis

Most cited articles on Facial nerve paralysis

Review articles on Facial nerve paralysis

Articles on Facial nerve paralysis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Facial nerve paralysis

Images of Facial nerve paralysis

Photos of Facial nerve paralysis

Podcasts & MP3s on Facial nerve paralysis

Videos on Facial nerve paralysis

Evidence Based Medicine

Cochrane Collaboration on Facial nerve paralysis

Bandolier on Facial nerve paralysis

TRIP on Facial nerve paralysis

Clinical Trials

Ongoing Trials on Facial nerve paralysis at Clinical Trials.gov

Trial results on Facial nerve paralysis

Clinical Trials on Facial nerve paralysis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Facial nerve paralysis

NICE Guidance on Facial nerve paralysis

NHS PRODIGY Guidance

FDA on Facial nerve paralysis

CDC on Facial nerve paralysis

Books

Books on Facial nerve paralysis

News

Facial nerve paralysis in the news

Be alerted to news on Facial nerve paralysis

News trends on Facial nerve paralysis

Commentary

Blogs on Facial nerve paralysis

Definitions

Definitions of Facial nerve paralysis

Patient Resources / Community

Patient resources on Facial nerve paralysis

Discussion groups on Facial nerve paralysis

Patient Handouts on Facial nerve paralysis

Directions to Hospitals Treating Facial nerve paralysis

Risk calculators and risk factors for Facial nerve paralysis

Healthcare Provider Resources

Symptoms of Facial nerve paralysis

Causes & Risk Factors for Facial nerve paralysis

Diagnostic studies for Facial nerve paralysis

Treatment of Facial nerve paralysis

Continuing Medical Education (CME)

CME Programs on Facial nerve paralysis

International

Facial nerve paralysis en Espanol

Facial nerve paralysis en Francais

Business

Facial nerve paralysis in the Marketplace

Patents on Facial nerve paralysis

Experimental / Informatics

List of terms related to Facial nerve paralysis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Facial nerve paralysis and Bell's palsy is due to a loss of voluntary movement of the muscles on one side of the face due to abnormal function of the facial nerve(s). A Peripheral palsy affects all ipsilateral muscles of facial expression (paralysis results on the entire ipsilateral side). A supranuclear palsy involves the lower part of the face.

Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. The pathway of the facial nerve is long and relatively convoluted, and so there are a number of causes that may result in facial nerve paralysis. The most common is Bell's palsy, an idiopathic disease that may only be diagnosed by exclusion.

A thorough medical history and physical examination are the first steps in making a diagnosis.

During the physical examination, a distinction must first be made between paralysis and paresis (incomplete paralysis). Not surprisingly, paralysis is far more serious and requires immediate treatment. It must also be determined whether the forehead is involved in the motor defect or not. This is usually accomplished by assessing how well a patient can raise her eyebrows. The question is an important one because it helps determine if the lesion is in the upper motor neuron component of the facial nerve, or in its lower motor neuron component.

Laboratory investigations include an audiogram, nerve conduction studies (ENoG), computed tomography (CT) or magnetic resonance (MR) imaging.

Causes

Common Causes

Bell's palsy

Bell's palsy is the most common cause of acute facial nerve paralysis (>80%). Previously considered idiopathic, it has been recently linked to herpes zoster of the facial nerve (rarely Lyme disease).

Bell's palsy is an exclusion diagnosis. Some factors that tend to rule out Bell's palsy include:

  1. Recurrent paralysis
  2. Slowly progressive paralysis (The onset of Bell's palsy is very sudden)
  3. Twitching
  4. Associated symptoms (either cochlear or neurologic)

Bell's palsy is believed in the most recent studies to be due to herpes virus. Other proposed etiologies include vascular problems in the inner ear. Treatment include steroids and antivirals.

Trauma

Physical trauma, especially fractures of the temporal bone, may also cause acute facial nerve paralysis. Understandably, the likelihood of facial paralysis after trauma depends on the location of the trauma. Most commonly, facial paralysis follows temporal bone fractures, though the likelihood depends on the type of fracture.

Transverse fractures in the horizontal plane present the highest likelihood of facial paralysis (40-50%). Patients may also present with hemotympanum (blood behind the tympanic membrane), sensory deafness, and vertigo – the latter two symptoms due to damage to vestibulocochlear nerve (cranial nerve VIII) and the inner ear. Longitudinal fracture in the vertical plane present a lower likelihood of paralysis (20%). Patients may present with hematorrhea (blood coming out of the external auditory meatus), tympanic membrane tear, fracture of external auditory canal, and conductive hearing loss.

Traumatic injuries can be assessed by computed tomography (CT) and nerve conduction studies (ENoG). In patients with mild injury, management is the same as with Bell's palsy – protect the eyes and wait. In patients with severe injury, progress is followed with nerve conduction studies. If nerve conduction studies show a large (>90%) change in nerve conduction, the nerve should be decompressed. The facial paralysis can follow immediately the trauma due to direct damage to the facial nerve, in such cases a surgical treatment may be attempted. In other cases the facial paralysis can occur a long time after the trauma due to oedema and inflammation. In those cases steroids can be a good help.

Tumors

A tumor compressing the facial nerve anywhere along its complex pathway can result in facial paralysis. Common culprits are facial neuromas, congenital cholesteatomas, hemangiomas, acoustic neuromas, parotid gland neoplasms, or metastases of other tumors.

Patients with facial nerve paralysis resulting from tumors usually present with a progressive, twitching paralysis, other neurological signs, or a recurrent Bell's palsy-type presentation. The latter should always be suspicious, as Bell's palsy should not recur. A chronically discharging ear must be treated as a cholesteatoma until proven otherwise; hence, there must be immediate surgical exploration.

Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumor, and it should be managed accordingly.

Herpes zoster oticus

Herpes zoster oticus is essentially a herpes zoster infection that affects cranial nerves VII (facial nerve) and VIII (vestibulocochlear nerve). Patients present with facial paralysis, ear pain, vesicles, sensorineural hearing loss, and vertigo. Management includes antivirals and oral steroids.

Acute and chronic otitis media

Otitis media is an infection in the middle ear, which can spread to the facial nerve and inflame it, causing compression of the nerve in its canal. Antibiotics are used to control the otitis media, and other options include a wide myringotomy (an incision in the tympanic membrane) or decompression if the patient does not improve

Chronic otitis media usually presents in an ear with chronic discharge (otorrhea), or hearing loss, with or without ear pain (otalgia). Once suspected, there should be immediate surgical exploration to determine if a cholesteatoma has formed and must be removed.

Neurosarcoidosis

Facial nerve paralysis, sometimes bilateral, is a common manifestation of neurosarcoidosis (sarcoidosis of the nervous system), itself a rare condition.

Differential Diagnosis of Facial nerve paralysis[1][2]

Physical Examination

  • Complete ears, nose, and throat (ENT) and neurologic exams with physical

Laboratory Findings

MRI and CT

Other Diagnostic Studies

Treatment

  • Massage of weakened muscles, tape eye and use eye shield during sleep and possible electrical stimulation of paralyzed muscles (Bell's palsy)
  • Treat underlying disease etiologies
  • Consider neurologic referral

Pharmacotherapy

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Additional Resources


Template:PNS diseases of the nervous system

de:Fazialislähmung hr:Kljenuti ličnog živca no:Facialisparese


Template:WH Template:WikiDoc Sources