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Boies > Chapter 8: Disease of the Facial Nerve > Flashcards

Chapter 8: Disease of the Facial Nerve Flashcards

1
Q

Is a peripheral seventh nerve paralysis

A

Bell’s palsy

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2
Q

Innervates facial motion
Provides lacrimation, salivation, impedance regulation of the middle ear
Senses of pain, touch, temperature and taste

A

Seventh cranial nerve

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3
Q

Begins at the brain stem and follows a course through the temporal bone, ending in the muscle of the face

A

Seventh cranial nerve

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4
Q

Seventh cranial nerve is in the region of the…

A

Pons

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5
Q

Innervates the ipsilateral and contralateral forehead

A

Precentral gyrus of the motor cortex

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6
Q

Innervates the contralateral portion of the remainder of the face

A

Cerebral cortical tracts

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7
Q

Innervates only the ipsilateral facial nerve

A

Motor nucleus

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8
Q

Branches of facial nerve

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical
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9
Q

AKA neuropraxia
Occurs when the conduction of impulses is blocked, damming axoplasm transport (both directions) with some axoplasm transport continuing

A

1st-degree injury or conduction block

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10
Q

Amount of pressure on the nerve is sufficient to completely block the movement of axoplasm past the site of injury over several days
Occurs with loss of axonal continuity
Results in wallerian degeneration distally

A

Axonetmesis (2nd-degree injury)

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11
Q

Axonetmesis and neurotmesis histologic findings

A
  1. Schwann cells become swollen and phagocytic
  2. Loses of Nissl substance with swelling of cytoplasm (chromatolysis)
  3. Formation of Büngner’s bands (provide a biochemical mode of attraction for new nerves)
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12
Q

Repair of a cut facial nerve is more likely to be effective if done…

A

21 days after the injury

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13
Q

Are branchiomeric muscles and greater muscle wasting is seen in somatic muscle than in branchiomeric muscle after loss of motor nerve

A

Facial muscles

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14
Q

Stages of facial nerve after injury

Stage 1

A
  1. Occurs up to 21 days
  2. Cell body undergoes metabolic transformation and begins to regenerate to create axoplasm that will inhabit the now empty neurotubules
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15
Q

Stages of facial nerve after injury

Stage 2

A
  1. Last up to 2 years
  2. Cell body and the proximal segment can regenerate using the Büngner’s bands or reserved endoneural tubes through which the regenerating axons can reach the facial muscles
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16
Q

It should be considered plausible to reanatomose the severed nerve, interpose a cable graft between the 2 points of loss of continuity or transfer another functioning motor nerve to the distal nerve segments

A

Up to 2 years after injury

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17
Q

Stages of facial nerve after injury

Stage 3

A
  1. Distal scarring and muscle degeneration

Precludes consideration of restoring neuromuscular continuity

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18
Q

Needs to have complete audiogram

A

Facial nerve palsy

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19
Q

Testing must include (facial nerve palsy)

A
  1. Air and bone conduction
  2. Tympanometry
  3. Stapes reflexes
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20
Q

Function of the 8th CN can be evaluated using…

A

Auditory brain stem evoked response (ABR test)

21
Q

Most helpful in detecting pathology in the internal auditory canal

A

ABR test

22
Q

Reflex testing

A

A loud tone is presented, either to the ipsilateral or contralateral ear–>evokes a reflex movement of the stapedius muscle–>changes the tension on the TM—>change in the impedance of the ossicular chain

23
Q

Reflex testing result

A

Tone is presented to the opposite ear: normal hearing ear and reflex is elicited (intact 7th nerve)
Absence of reflex when either ear is stimulated: abnormality of the afferent 7th CN

24
Q

Tearing function of the eye can be evaluated
Strips are placed over the lower lid into the conjunctival sac on both sides
After 3 minutes, the length of the strip that is moist compared to the opposite side
A difference of greater than 25% suggest potential involvement of 7th CN

A

Schirmer test

25
Q

The side of less tearing is interpreted to represent greater superficial petrosal nerve activity due to…

A

Loss of action in the parasympathetic nerve of Wrisberg

26
Q

Is a reliable indicator of interruption of the function of the chorda tympani nerve
Loss of taste due to injury is limited to the anterior 2/3 of the tongue and stops at the midline

A

Measurement of taste

27
Q

Can be performed by cannulating the submandibular glands

Reduction in salivary flow of 25% is considered abnormal

A

Salivation test

28
Q

Nerve function tests

A
  1. Electromyography (EMG)
  2. Electroneuronography (ENOG)
  3. Maximal stimulation tests
29
Q

Nerve function test frequently performed

Determining the patient’s course in reinnervation responses

A

EMG

30
Q

A positive sign showing recovery of some fibers

Not seen before 21 days

A

Fibrillation potentials

31
Q

Carries put a stimulation at one point and measurement of the EMG at a more distal point on the nerve
If there is a 90% reduction at ten days, chances of recovery are significantly reduced

A

ENOG

32
Q

The probe is pressed against the face in the area of the facial nerve
Current is slowly increased to 5 ma, or until the patient has discomfort
Forehead, eyebrow, periorbital area, cheek, nasal ala and lower lip are tested

A

Maximal stimulation test

33
Q
  1. External and middle ear anomalies
  2. Involvement of CN 3, 5, 6, 7 and 12
  3. Facial nerve forms (fibrotic tract)
  4. Muscle development may be present (rapidly degenerates to fibrosis)
  5. No response to any electrical testing
  6. Not develop any form of facial movement
A

Möbius syndrome

34
Q

Congenital lesion (facial nerve paralysis)

A
  1. Möbius syndrome

2. Childbirth trauma

35
Q

Infections (facial nerve paralysis)

A
  1. Meningitis
  2. Ramsay Hunt syndrome (herpes zoster oticus)
  3. Bacterial infections of the middle ear
  4. Lyme disease
36
Q

Is a common cause of facial palsy

A

Trauma to the temporal bone

37
Q

Facial nerve evaluation should be performed immediately on any patient with a

A

Basilar skull fracture

38
Q

Vascular lesion (facial palsy)

A
  1. Aneurysm

2. Thrombosis of major vessel

39
Q

Neoplasm (facial palsy)

A
  1. Tumors of cerebellopontine angle (acoustic neuroma, meningioma)
  2. Glomus jululare
  3. Histiocytosis
  4. Rhabdomyosarcoma
  5. Squamous cell carcinoma
40
Q

Development of facial nerve paralysis in a patient with external otitis suggests

A

Malignancy

41
Q

Idiopathic causes (facial palsy)

A
  1. DM
  2. Melkersson-Rosenthal syndrome
  3. Bell’s palsy
42
Q

Most common cause of unilateral facial paralysis
Recovery of function within 6 months
Upper respiratory inflammation symptoms may precede

A

Bell’s palsy

43
Q

When electrical tests show identical responses on both sides…

A

Prognosis for recovery of nerve function is excellent

44
Q

Complications of facial nerve paralysis

A
  1. Drooling
  2. Inability to whistle
  3. Trouble with speaking clearly
  4. Biting the buccal mucosa (loss of motor tone)
  5. Popping of food in the paralyzed buccal pouch
45
Q

When facial nerve grafting is not possible, other cranial nerves in the area can be used

A
  1. Spinal accessory nerve

2. Hypoglossal nerve

46
Q

Medical therapy for Bell’s palsy requires..

A

Attention to the paralyzed eyelid

47
Q

Medical therapy for Bell’s palsy

A

Prednisone 1 mg/kg/day up to 14 days

48
Q

Surgery treatment for Bell’s palsy

A
  1. Transmastoid facial nerve decompression from the geniculate ganglion distally to the level of the stylomastoid foramen
  2. Middle fossa decompression

Boies (27 decks)

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