2 - ENT - Facial nerve palsy - Causes + Bell's palsy

Question 1

Children - two congenital causes + what else do they give

Answer 1

Moebius syndrome - bilateral VI and VII palsies

Hemifacial microsomia - hemifacial hypoplasia (mainly ears mouth) + VII palsy

Question 2

Children - 3 acquired causes

Answer 2

forceps delivery - VII v superficial in younger people
chicken pox VZV
Acute otitis media

Question 3

Adults - 4 groups of causes t

Answer 3

Peripheral causes

middle ear causes

Intratemporal causes

Intracranial causes

Question 4

4 peripheral causes

Answer 4

Trauma
Iatrogenic - surgery
Tumours - parotid Ca
Inflammatory - sarcoidosis

Question 5

5 middle ear causes

Answer 5

Trauma
Iatrogenic - any ear surgery
CHOLESTEATOMA
Infection
Tumours - eg SCC

Question 6

Infection of middle ear causing VII palsy - what is an emergency? what could it be? 3 other infections?

Answer 6

emergency = discharging ear and facial palsy - may be infected cholesteatoma

Acute OM
Mastoiditis
Herpes zoster

Question 7

What may happen with Herpes zoster infection of middle ear, to cause VII palsy

Answer 7

RAMSAY HUNT syndrome - reactivation of VZV in genticualte ganglion of VII - can affect VII > tinnitus, vertigo, deafness

Question 8

Intratemporal causes of VII palsy

Answer 8

Trauma - eg transverse skull fracture

Tumours eg SCC, Cholesteatoma

Question 9

Intracranial causes

Answer 9

Tumours
Iatrogenic - skull base surgery
Vascular -stroke
Neuro -MS

Question 10

What tumours intracranially may result in VII palsy

Answer 10

facial nerve neuroma, acoustic neuroma, meningioma, neoplastic meningitis

Question 11

Bell’s palsy - incidence? how is it diagnosed?

Answer 11

diagnosis of exclusion - no CNS/ear pathology

~20 per 100000/y

Question 12

Bell’s palsy - cause?

Answer 12

VII nerve palsy - possibly by inflam oedema of nerve in facial canal

• due to virus HSV/VZV
• may be accompanied by demyelination

Question 13

Bell’s palsy - Sx

Answer 13

Very acute onset
normally unilateral
- mouth sagging
-drooling
- watering/dry eyes
- impaired expressions
- dropping of eye lids

Question 14

Bell’s - mgmt + prognosis

Answer 14

mgmt - early steroids, high dose antivirals possibly
Prog - recovery usually begins withing 2 months
- 1/3 recover
- 1/3 largely recover
- 1/3 permanent significant abnormalities

poor prog with age, pain, complete palsy