Facial Nerve Palsy

Question 1

Course of the facial nerve

Answer 1

Passes through the temporal bone and through the parotid gland

Question 2

Branches of the facial nerve

Answer 2

Temporal 
Zygotic 
Buccal 
Marginal mandibular 
Cervical

Question 3

Functions of the facial nerve

Answer 3

Motor:

• muscles of facial expression
• the stapedius in the ear
• posterior digastric
• stylohyoid
• platysma

Sensory - taste from the anterior 2/3rds of the tongue

Parasympathetic- submandibular and sublingual salivary glands and the lacrimal glands

Question 4

UMN facial nerve palsy

Answer 4

Forehead spared

Question 5

Cause of UMN facial palsy

Answer 5

Stroke

Brain tumour

Question 6

Cause of LMN palsy

Answer 6

Bell’s palsy
Ramsay Hunt syndrome
Lyme’s disease
Otitis media

Systemic:

• sarcoidosis
• diabetes
• multiple sclerosis
• leukeamia

Tumours:

• acoustic neuroma
• parotid tumours
• cholesteotoma

Trauma:

• basal skull fracture
• surgery

Question 7

Presentation of LMN facial palsy

Answer 7

No forehead sparing

Question 8

Bell’s palsy

Answer 8

Unilateral, LMN facial palsy due to inflammation of the facial nerve

Question 9

Treatment of Bell’s palsy

Answer 9

50mg prednisolone - 10 days

Lubricating eye drops

Question 10

Complication of Bell’s palsy

Answer 10

Exposure keratopathy - ophthalmology review

Question 11

Ramsay Hunt syndrome pathophysiology

Answer 11

Varicella zoster virus affecting the LMNs of the facial nerve

Question 12

Presentation of Ramsay Hunt syndrome

Answer 12

Unilateral LMN facial nerve palsy

Painful and tender vesicular rash around the ear on the affected side

Question 13

Treatment of Ramsey Hunt syndrome

Answer 13

Prednisolone and Acyclovir within 72 hours

Lubricating eye drops