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AUDE 5410 Aud-Vestib Disorders > Facial Nerve Disorders > Flashcards

Facial Nerve Disorders Flashcards

1
Q

innervation of the skeletal muscles

A

somatic motor

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2
Q

innervation of smooth muscles

A

visceral motor

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3
Q

sensation from viscera (includes taste and smell as they are associated w/ digestive tract

A

visceral sensory

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4
Q

Sensation from sensory organs, skin, skeletal muscles, and connective tissue

A

somatic sensory

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5
Q

Cranial nerves III (CNIII) (oculomotor), IV (trochlear), and VI (abducens) control the position of the ______ through various muscles.

A

eyeballs

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6
Q

helps to adjust and coordinate eye position during movement. Several movements assist with this process: saccades, smooth pursuit, fixation, accommodation, vestibulo-ocular reflex, and optokinetic reflex.

A

occulomotor

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7
Q

largest of the cranial nerves,

A

trigeminal nerve

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8
Q

what are the sensory nerves

A

olfactory
optic
vestibulocochlear

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9
Q

what are motor nerves

A

oculomotor
trochlear
abducens
accessory
hypoglossal

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10
Q

what are mixed nerves

A

trigeminal
fanical
glossopharyngeal
vagus

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11
Q

CN 1 2 3 are somatic or visceral and motor or sensory?

A

cn 1 is visceral sensory
cn 2 and 3 are somatic sensory

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12
Q

CN 3, 4, 6, 11, 12 are somatic or visceral and motor or sensory?

A

all are somatic motor

cn 3 is visceral motor

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13
Q

cn 5, 7, 9, 10 are somatic or visceral and motor or sensory?

A

7,9, 10 are all 4
5 is somatic motor and somatic sensory

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14
Q

muscles of facial expression
furrowing forehead, raising eyebrow, pursing lips, closing eyes

A

somatic motor innervaton

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15
Q

responsible for PAM (post auricular muscle reflex)

A

postauricular muscle

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16
Q

somatic motor innervation

A

muscles of facial expression
postauricular muscle
stapedius muscle

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17
Q

ME acoustic reflex

A

stapedius

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18
Q

visceral motor innervation

A

lacrimal and salivary glands

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19
Q

tear ducts

A

lacrimal

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20
Q

taste in anterior 2/3 of tongue (chorda tympani nerve)

A

visceral sensory innervation

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21
Q

posterior eac, concha, ear lobe, deep parts of face

A

somatic sensory innervation

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22
Q

mixed nerve derived from the second pharyngeal arch

A

facial nerve

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23
Q

runs a complex three-dimensional course

A

facial nerve

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24
Q

facial nerve course in cranium

A

Arises from the anterior part of the pons
Exists the brainstem at the pontomedullary junction
Passes through the cerebellopontine angle (CPA) to enter the IAC

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25
Q

This canal narrowing is a common site for facial nerve entrapment and associated disorders

A

Internal auditory canal or meatus (meatal) segment

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26
Q

runs between the VII and VIII N and provides vascular supply to this segment of the VII nerve

A

AICA

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27
Q

branch of VII N) lies between the VII and VIII N in the IAC

A

chorda tympani

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28
Q

Common site of pathology; temporal bone fractures & Bell’s palsy

A

Labyrinthine segment aka Intratemporal portion

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29
Q

what are intratemporal portions of facial nerve

A

labyrinthine segment
tympanic segment
mastoid segment

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30
Q

The facial nerve is readily injured here in pathologic processes and during ME surgery

A

tympanic segment

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31
Q

It shows variable branching patterns in the face

A

mastoid segment

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32
Q

exits the temporal bone via the stylomastoid foramen

A

mastoid segment

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33
Q

The course of the facial nerve makes it vulnerable to many

A

neoplastic, traumatic, and infectious conditions.

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34
Q

The incidence of newborn facial paralysis is _______%

A

~ 0.2%

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35
Q

Pediatric facial nerve paralysis can be

A

Congenital
Prenatal acquired
Postnatal acquired

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36
Q

what is congenital pediatric fn paralysis

A

Developmental errors during embryogenesis

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37
Q

what is prenatal acquired pediatric fn paralysis

A

Typically, due to intrauterine trauma, for example,
Forceps compression during delivery or compression of the side of face against the sacrum during labor
Fetal exposure to teratogens, for example,
Maternal rubella

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38
Q

what is postnatal pediatric fn paralysis

A

Many of the same conditions that can affect adults
Most commonly trauma and infections

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39
Q

also called Albers-SchÖnberg Disease

A

Osteopetrosis

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40
Q

what is osteopetrosis

A

an ad genetic conditionpresent at birth with varying severity and is a milder form than the AR condition, which is more severe

It is a bony dysplasia; the bones harden and become denser

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41
Q

Causes multiple cranial neuropathies because of bony obliteration of neural foramina with entrapment and compression of cranial nerves

A

osteopetrosis

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42
Q

Progressive or fluctuating involvement of CN II, V, VII, VIII in osteopetrosis

A

Congenital facial paralysis
Vision (even blindness) and hearing loss (even deafness) are common

43
Q

treatment for osteopetrosis

A

Symptomatic
Facial nerve decompression if nerve entrapment and associated facial dysfunction

44
Q

bony dysplasia

A

abnormal growth-dense bone

45
Q

Rare congenital disorder associated with hypoplasia of 6th (Abducens – moves the eye laterally) and 7th (Facial) cranial nerve nuclei

A

Mobius syndrome

46
Q

somatic efferent nerve that, in humans, controls the movement of a single muscle, the lateral rectus muscle of the eye, which moves the eye sideways, away from the nose.

A

Abducens (CN VI)

47
Q

A condition in which tissue or an organ of the body fails to grow to normal size.

A

Hypoplasia

48
Q

what is etiology of Mobius syndrome

A

Genetic with multiple genes and modes of inheritance (multifactorial)
Exposure in utero to teratogens such as
Cocaine
Ergotamine
Misoprostol (synthetic prostaglandin E1

49
Q

alkaloid used as a vasoconstrictor to treat migraine, induce childbirth, and prevent post-partum hemorrhage

A

ergotamine

50
Q

Vasodilator used to prevent stomach ulcers & sometimes used as a treatment for tinnitus

A

Misoprostol (synthetic prostaglandin E1)

51
Q

symtpoms of mobius syndrom

A

Congenital facial diplegia (bilateral facial paralysis)
Associated CN VI unilateral or bilateral paralysis
Other cranial nerve deficits
Deformities of extremities
Musculoskeletal deformities
Intellectual disability

52
Q

mobius treatment

A

Ophthalmologic consultation
Nerve reconstructive surgery

53
Q

most common cause of acute unilateral facial paralysis
Accounting for approximately 60 to 75% of such cases
Although bilateral facial paralysis can also occur, the occurrence rate is <1% when compared to unilateral

A

Bell’s palsy

54
Q

It can also be recurrent in ~ 4 to 14% of affected individuals
Right side is generally affected more often, ~ 63% of the time

A

bells palsy

55
Q

affects both sexes equally
Although the condition is more frequent in younger women (aged 10-19) compared to the same age group of men

A

bells palsy

56
Q

Pregnancy can increase the risk threefold, most commonly during the third trimester
Preeclampsia can increase the risk of occurrence

A

bell’s palsy

57
Q

(disorder of pregnancy with high blood pressure and proteins in the urine)

A

preeclampsia

58
Q

etiology of bells palsy

A

Idiopathic (most common - diagnosis of exclusion)
Herpes simplex virus (main infectious agent)
Rarely caused by a otitis media, cerebello-pontine angle (CPA), parotid gland or skull-based tumors, or metastatic lesions
Begins with the sensory fibers and then involves motor fibers

59
Q

Inflammatory response (especially swelling) leading to compression/ischemia of the nerve at the meatal foramen and labyrinthine segment
Nerve degeneration can occur

A

entrapment from herpes simplex virus

60
Q

a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing

A

exclusionary diagnosis

61
Q

how to diagnose bells palsy

A

Onset of partial/total unilateral facial paralysis during a 48-hour period
Fever and neck stiffness at the onset
No hearing loss or vertigo
No other cranial neuropathy
Normal head and neck examination
Drying of eye due to decreased eye closure and lack of lacrimation
Rare cases of recurrence
Some spontaneous recovery should be noted within 3 to 6 months in all patients

62
Q

what is audio findings of bells palsy

A

normal otoscopy
HL is rare in pure tones
normal tymps
ABNORMAL ARTS or PRESENT ARTs

63
Q

Abnormal ARTS due to a lesion

A

proximal to the stapedius nerve

64
Q

Presence of ARTs indicates

A

lesion distal to the stapedius nerve

65
Q

Facial nerve tests most commonly used today include

A

electroneurography (ENOG) - most useful, electromyography (EMG), the nerve excitability test (NET), and the maximum stimulation test (MST)

66
Q

what is ENOG

A

stimulating electrode is placed proximally over the nerve trunk and a second electrode is placed distally over muscle. Current is applied in the first electrode and response is detected in the second electrode. The response is measured bilaterally and the healthy side is compared to the weak side. The magnitude of the response on the weak side is calculated as a percentage of the response on the healthy side.

67
Q

what is the advantage of ENOG

A

objective measure of the amount of intact axons relative to the healthy side. Degeneration greater than 90% is correlated with a poor prognosis.

68
Q

what is done if function doesn’t return 6 mos post paralysis

A

ENOG to assess degeneration of nerve fibers
CT & MRI - for differential from VII n tumors

69
Q

treatment for bells palsy

A

Decompression of the nerve is indicated when > 90% degeneration occurs within 2 weeks of onset

Steroids indicated early in the course of the disease

Acyclovir (antiviral) with steroids (inconsistent data re: benefits)

Eye care to prevent permanent damage due to dryness of eye

70
Q

involves relieving pressure on the nerve possibly by removing part of the surrounding bone

A

Decompression

71
Q

what are differential diagnoses for bells palsy

A

CPA or skull-based tumors
Vestibular schwannoma
Otitis media
Parotid gland tumors

72
Q

what is prognosis of bells palsy

A

Majority of patients recover function within 3 to 6 months with no medical or surgical intervention except eye care as needed

73
Q

what factors lead to good prognosis with recovery of function

A

younger patients

partial paralysis &recovery within 2 mos

intact ART

EMG evidence of voluntary activity

ENOG shows <90% degeneration of electrically evoked muscle action potential after about two weeks of onset

74
Q

poor prognosis of recovery of function for bells palsy

A

Patients older than 65 years
Greater than 90% nerve degeneration within the first two weeks as diagnosed with ENoG
Diabetic patients

75
Q

why diabetic pt’s for bells palsy poor prognosis

A

because of a peripheral circulatory disorder that develops in the feeding vessels to the facial nerves

76
Q

injury during surgical procedures

A

iatrogenic injury

77
Q

Incidence 0.5 to 4%
The most common site of injury is the tympanic segment over the oval window; e.g., injury during otosclerosis and cholesteatoma surgery

A

iatrogenic injury

78
Q

Most common site of injury is adjacent to the geniculate ganglion
Hearing loss (conductive, mixed or SNHL) is common

A

temporal bone fractures

79
Q

what are traumas causing fn disorders

A

temporla bone fractures

iatrogenic injury

lacerations

gunshot wounds

80
Q

Invasion of pseudomonas pneumoniae and other bacteria into the soft tissue, cartilage, and bone

A

etiology of malignant otitis externa

81
Q

treatment of malignant otitis externa

A

Debridement of infected tissue
Decompression of facial nerve when needed
Antibiotics

82
Q

Caused by gram-positive bacteria and Haemophilus influenzae
Invasion into the facial canal through a dehiscence may evoke an inflammatory response with edema, compression, and ischemia resulting in facial weakness

A

acute suppurative otitis media

83
Q

treatment of facial paralysis secndary to inflammatory ME disease

A

Myringotomy
Appropriate antibiotics
Trans-mastoid decompression if nerve degeneration is progressive

84
Q

Facial nerve paralysis secondary to _____ is fairly common
Paralysis can occur with or without cholesteatoma

A

chronic otitis media

85
Q

treatment of otitis media

A

urgent indication for surgical intervention
Tympano-mastoidectomy is appropriate for the chronic ear infection followed by decompression of involved facial nerve
Removal of cholesteatoma, if present, adherent to the nerve

86
Q

Caused by the varicella zoster virus (herpes family) - shingles

A

Herpes zoster oticus (Ramsay-Hunt Syndrome)

87
Q

signs of Herpes zoster oticus (Ramsay-Hunt Syndrome)

A

Otalgia and severe pain
Vesicular eruption on the concha and/or external canal and along the sensory distribution of 7th cranial nerve
Facial paralysis that tends to be more severe
Hearing loss
Vertigo
Higher frequency of complete degeneration of the facial nerve

88
Q

site of pathology of herpes

A

Labyrinthine segment of the facial nerve
Can involve CNs V, IX, X, XI
Herpes zoster cephalicus, which is rare and involves cervical dermatomes (skin areas)

89
Q

treatment for herpes

A

antiviral medication, Acyclovir

90
Q

prognosis of herpes

A

Less chances of complete spontaneous recovery than Bell’s palsy
Chances of recovery low even with steroid administration

91
Q

are benign neoplasms of schwann cells
They comprise < 1% of all intrapetrous mass lesions

A

Primary facial neuromas or schwannomas

92
Q

symptoms of facial neuroma

A

Facial weakness (2/3 of all cases)
Most facial weakness or paralysis is gradual but sudden onset of paralysis has been reported

Hearing loss (~ 50% of all patients)
Can be SNHL, conductive, or mixed depending on tumor location

93
Q

Other symptoms, in 10 to 15% of cases

A

Tinnitus
Otorrhea
Ear canal mass
Otalgia
Vestibular symptoms

94
Q

If the lesion is on the mastoid segment of CN VII and invading the ME cavity, ear canal, or in the tympanic portion, a _______ is possible

A

conductive hearing loss

95
Q

what is tumor location of facial neuroma

A

variable
58% in the tympanic segment
48% in the vertical segment (lesion proximal to stapedius nerve)
42% in the labrynthine segment and geniculate body
30% in the IAC
19% in the CPA
14% in the stylomastoid foramen

96
Q

If tumor is confined to IAC or CPA, ______ facial symptoms maybe present

A

no

97
Q

audios for facial nerve neuromas

A

Pure-tone audiometry – generally SNHL due to cochlear nerve compression by the tumor
Immittance audiometry
Normal tympanogram
Abnormal ARTS due to a lesion proximal to the stapedius nerve
Presence of ARTs indicates lesion distal to the stapedius nerve
Lesion likely in the mastoid or extratemporal segment of the facial nerve

98
Q

determine if a tumor is an acoustic or facial neuroma

A

abr

99
Q

ARTs are abnormal whenever measured on the affected side

A

true

100
Q

Whenever an ART is measured in the right ear (right ipsilateral and left contralateral) ARTs are absent

A

true

101
Q

management of facial nerve

A

Controversy over whether or not to surgically remove small facial neuromas

Radiotherapy to decrease tumor size before surgery or if causing pressure on critical structures such as the brainstem

Decompression of facial nerve if paralysis or other symptoms

Tumor resection if warranted, with facial nerve grafting from a sensory nerve

102
Q

sensory nerve in the calf region (sura) of the leg. It is made up of collateral branches of the tibial nerve and common fibular nerve.

A

sural nerve

103
Q

differential diagnosis of facial neuroma

A

Otitis media with conductive hearing loss
With or without cholsteatoma

Cholesteatoma
Requires prompt decompression of the VII N and resection of the cholestatoma

Glomus tumor (Paragangliommas – ME & jugular vein bulb)

Meningiomas

Tumor of the meninges

`Acoustic neuroma (vestibular schwannoma)
Both VII and VIII nerve schwannomas have been reported in some cases of NF2

AUDE 5410 Aud-Vestib Disorders (18 decks)

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