ENT - Facial Paralysis Flashcards
What term describes loss of axoplasm flow, a nerve bruise?
Neurapraxia
What differentiates axonotmesis and neurotmesis?
Axonotmesis - wallerian degeneration with preservation of endoneural sheaths
Neurotnesis - Wallerian degeneration + loss of endoneural tubules
What are Sunderland’s 5 levels of nerve injury?
1st-degree - neuropraxia
2nd-degree - neuronesis
3rd-degree - neurotmesis with loss of endoneurium
4th-degree - neurotmesis with loss of endoneurium and perineurium
5th-degree - neurotmesis with loss of endo, peri-, and epineurium
How do you differentiate the 6 grade of Brackmann - facial nerve grading system?
Normal (1) vs. Total paralysis (6) - completely fine or total loss
Mild (2) vs Severe (5) - Slight weakness vs slight movement
Moderate (3) vs Moderate-Severe (4) - Complete closure of eye with effort vs. incomplete closure of eye with effort
What should electrophysiologic tests (EMG, ENG) be done?
Only Brackmann 6
What is the test of choice for an acoustic schwannoma or neuroma?
MRI w/ gadolinium
If an EMG is going to be ordered, what time frame(s) should it be ordered in? Why avoid a certain window?
Do <1 week or >2 weeks to avoid period of wallerian degeneration
Do NOT do for paresis
What is the treatment for Bell’s Palsy?
Predinsone w/in first 2 days (60-80mg/kg) and stay on it for 7-10 days
Acyclovir 2000 mg/day in 5 doses for 7 days
What is Battle Sign? What does it suggest?
Bruising behind ear - temporal bone fracture
What is the most common cause of Bell’s Palsy? What are others on differential?
HSV
Neoplasia - cholesteatoma, facial neuroma, schwannoma, etc.
What two things can EMG not tell the difference between in the acute phase?
Neurapraxia and completely degenerated nerve
What is the most common complication after onset of facial paralysis?
Corneal desiccation (eye injury)
