Facial Nerve Palsy

Question 1

What are causes of facial nerve palsy?

Answer 1

Bell’s palsy
Trauma - base of skull fracture
Infection - Ramsay hunt syndrome, meningitis, TB, HIV
Brain stem lesions - stroke, MS, tumours
Acoustic neruoma
ENT - parotid tumours, cholesteatoma, otitis media, barotrauma
Systemic disease - diabetes, sarcoidosis, guillian-barre syndrome

Question 2

What is the presentation of facial nerve palsy?

Answer 2

Usually unilateral
Facial droop
Sagging of mouth
Snarl on smiling
Drooling of saliva
Failure to close eyelids
Unable to wrinkle forehead
Dysarthria, decreased taste and hypersensitivity to sound

Question 3

How are upper motor neuron and lower motor neuron causes of facial palsy differentiated?

Answer 3

UMN - preservation of forehead wrinkling

LMN - loss of forehead wrinkling on affected side

Question 4

What is Bell’s palsy?

Answer 4

Lower motor neurone palsy of the facial nerve

Question 5

What is the cause of Bell’s palsy?

Answer 5

Exact cause unknown
Viral trigger?
Incidence higher in pregnancy and diabetes

Question 6

What is the presentation of Bell’s palsy?

Answer 6

Sudden onset facial weakness with associated symptoms

Question 7

How is diagnosis of Bell’s palsy made?

Answer 7

Clinical

Diagnosis of exclusion - no other cranial nerves affected

Question 8

What is the management of Bell’s palsy?

Answer 8

Within 72 hours - prednisolone to speed recovery

After 72 hours - none given

Question 9

What is the prognosis of Bell’s palsy?

Answer 9

Majority make full recovery over 4-12 weeks

Unlikely to reoccur