Ch 18 - Orofacial Pain Flashcards
What are the 2 alternate names for Bell palsy?
- Idiopathic Seventh Nerve Paralysis
2. Idiopathic facial paralysis
What are the main two theories for the etiology of Bell palsy?
herpes infection (HSV or VZV)
or
cell-mediated autoimmune reaction
Bell palsy can develop at any age, but whats the most common?
young and middle-aged adults
How long does Bell palsy take to completely set in?
Hours - pts usually wake up in full paralysis, can have prodromal symptoms
It is infrequent for Bell palsy to be bilateral, what are 4 other conditions that present with this bilateral, rapid onset?
- Guillain-Barre syndrome
- uveoparotid fever (AKA acute sarcoidosis aka Heerfordt syndrome)
- if other CN deficits consider a CNS infectious disease or a basilar skull tumor
- +vertigo, +tinnitus = Ramsay Hunt syndrome (VZV)
What is the treatment for Bell palsy?
self limiting, should resolve in 3-4 months..if no recovery systemic corticosteroids (see other flashcard)
What % of Bell palsy patients may not have a complete recovery?
20-30%
So assuming that Bell palsy was not self limiting and did not recover after 3-4 months, what treatment is given? Be specific with the regimen… What is NOT recommended?
10 day taper of prednisone starting at 60mg/day + antiviral (acyclovir, famciclovir, or valacyclovir)…NOT recommended: antiviral therapy alone
Eye protection for Bell palsy patients is critical so what can we do?
topical ocular antibiotics and artificial tears may be required to prevent corneal ulcer
What are the 2 alternate terms for Frey syndrome?
- Auriculotemporal syndrome
2. Gustatory sweating and flushing
What are the characteristics of Frey syndrome?
- Facial flushing and sweating along the auriculotemporal nerve
- in response to gustatory stimulus
- caused by injury to the nerve
What % range of patients with a history of a parotidectomy will develop Frey syndrome?
40-70%
What is the objective test for Frey syndrome?
Minor starch-iodine test
What systemic condition can cause bilateral gustatory sweating, thus mimicing Frey syndrome?
1/3 of diabetics WITH neuropathy esp severe kidney damage
What are two “related” phenomena to Frey syndrome that accompany an operation or injury to the submandibular gland or the facial nerve proximal to the geniculate ganglion?
- submandibular gland = chorda tympani syndrome
2. facial nerve proximal to the geniculate ganglion = gustatory lacrimation syndrome aka “crocodile tears”
How long does it take for the effects of Frey syndrome to present following the nerve injury?
2 months to 2 years
What color will present in a positive Minor iodine-starch test for a Frey syndrome patient?
blue
What % of adult patients and infants with Frey syndrome can have complete resolution without intervention?
5% of adults, almost all infants
What treatment can be effective long term for Frey syndrome?
botox injectons