ENT - Facial Nerve Palsy Flashcards
What is the path of the facial nerve?
Leaves the pons at the cerebellopontine angle
Passes through the temporal bone and parotid gland where it splits into two branches to supply face
What are the five branches of the facial nerve?
- Temporal
- Zygomatic
- Buccal
- Marginal mandibular
- Cervical
What are the motor functions of the facial nerve?
- Facial expression
- Stapedius in the inner ear
- Posterior digastric, stylohyoid, and platysma muscles
What sensory function does the facial nerve provide?
Taste from the anterior 2/3 of the tongue
Which glands receive parasympathetic supply from the facial nerve?
- Submandibular and sublingual salivary glands
- Lacrimal gland (stimulating tear production)
What distinguishes upper motor neurone lesions from lower motor neurone lesions in terms of forehead movement?
Upper motor neurone lesions spare forehead movement; lower motor neurone lesions do not
What are common causes of unilateral upper motor neurone lesions?
- Cerebrovascular accidents (strokes)
- Tumours
What are rare causes of bilateral upper motor neurone lesions?
- Pseudobulbar palsies
- Motor neurone disease
What is Bell’s palsy?
Idiopathic inflammation of the facial nerve leading to dysfunction
What is the typical recovery time for Bell’s palsy?
Most patients recover over several weeks, but recovery can take up to 12 months
What treatment is recommended within 72 hours of Bell’s palsy symptoms?
- Prednisolone 50mg for 10 days
- 60mg for 5 days followed by a reducing regime
- Must also have lubricating eye drops to prevent exposure keratopathy
What are the typical symptoms of Ramsay-Hunt syndrome?
Unilateral lower motor neurone facial nerve palsy with a painful vesicular rash in the ear canal and around the ear
Due to VZV affecting the genniculate ganglion of the facial nerve
Rash can extend to anterior two thirds of the tongue and hard palate
What is the treatment for Ramsay-Hunt syndrome?
- Aciclovir
- Prednisolone
- Lubricating eye drops
What infections can cause lower motor neurone facial nerve palsy?
- Otitis media
- Otitis externa
- HIV
- Lyme disease
What systemic diseases can lead to lower motor neurone facial nerve palsy?
- Diabetes
- Sarcoidosis
- Leukaemia
- Multiple sclerosis
- Guillain–Barré
What types of tumours can cause lower motor neurone facial nerve palsy?
- Acoustic neuroma
- Parotid tumour
- Cholesteatoma
What types of trauma can lead to lower motor neurone facial nerve palsy?
- Direct nerve trauma
- Surgery
- Base of skull fractures
