2 - ENT - Facial nerve palsy - Signs, Examination, Investigations and Management

Question 1

LMN vs UMN palsy

Answer 1

LMN - whole of one side

UMN - forehead spared

Question 2

Major facial palsy signs

Answer 2

unilateral facial paralysis/weakness - drooling, eye dropping
loss of lacrimation
taste deficit
loss of stapedius reflex (acoustic reflex - reduced sound tolerance)
decreased SML/SLingual saliva production

Question 3

Other aspects of history to ask about

Answer 3

otological Sx
parotid Sx
neuro disease - CVA, MS
trauma
systemic disease - infection, sarcoid

Question 4

3 parts of examination if ?facial nerve palsy

Answer 4

full neuro exam,
examine ears for infection, tumours
examine parotids

Question 5

What is used to grade VII palsy severity

Answer 5

House Brackmann Scale

Question 6

Outline the house brackmann scale

Answer 6

I - normal
II - weakness only noticed on close inspection
III - weakness, not disfiguring
IV - reduction in movement - incomplete eye closure
V - asymmetry at rest - hard to see any motion
VI - asymmetry at rest - no facial movement

Question 7

Ix for VII palsy

Answer 7

stapedial reflex testing
Schiermers test for lacrimation
pure tone audiogram
CT/MRI
electroneuronography

Question 8

Mgmt of VII palsy

Answer 8

eye care - artifical tears, can partly suture eyes closed

Facial reanimation surgery - muscle and nerve grafts