Facial Nerve Palsy Flashcards
What does the Facial Nerve innervate? Function?
- innervates ipsilateral muscles of facial expression, digastric and the stylohyoid muscle and the stapedius muscle of the middle ear
- innervates salivary and lacrimal glands
- transmits sensation from the ant 2/3 of the tongue
Pt presents with complete paralysis of R side of face
What is a potential red flag? Is medical attention advised?
Stroke, medical attention recommended
How does Stroke present compared to Bell’s Palsy?
Stroke is an UMN lesion –> contralateral weakness to the lower side of the face
Bell’s Palsy is a LMN lesion –> ipsilateral weakness of the upper AND lower side of face.
A pt is asked to smile and you notice a weakness on the R upper and lower side of the face. Ideentify the most likely location of his nerve injury:
a) left facial canal
b) left primary motor cortex
c) right facial canal
d) right primary motor cortex
C) Right facial canal –> R facial bell’s palsy
- weakness on the whole R side indiciating a LMN lesion
- LMN desecends through the facial canal
A pt is asked to smile and you notice weakness on the R side of their mouth. Identify the most likely location of their nerve injury:
a) Left facial canal
b) left primary motor cortex
c) right facial canal
d) right primary motor cortex
B) L primary motor cortex -> L sided stroke
- Forehead is spared indicating an UMN lesion
- Contralateral side indicating primary motor cortex
What is Facial Nerve Palsy?
reduced/absent conduction of the facial nerve due to trauma/damage
What can cause FNP?
Bell’s Palsy is the most common cause - acute onset of idiopathic FNP typically progressing over 72 hours
it can also be caused by an infection, tumour, fracture and surgery
What are the symptoms of FNP?
may include:
- complete/partial hemifacial paresis
- incomplete eye closure
- decrease taste in the 2/3 of ant tongue
- dryness of eye/mouth
- increase sensitivity to sounds
- difficulty with speech, eating and/or drinking
What is the medical management of FNP?
- corticosteroids
- antiviral medication
- eye care (keep eye moist, tape to close eye)
- PT
What may you include in PT assessment? Why?
- subjective hx
- HxPI
- facial mov’t: ask to raise eyebrows, smile, close eye, blow air into one cheek
- facial sensation: cotton swab on cheek, forehead
- screening cranial nerves
- goals
What is recovery like?
- Can vary, recovery is better in individuals with INCOMPLETE PARALYSIS than complete paralysis.
- Generally most pts with Bells’ palsy have SOME recovery without intervention within 2-3 weeks after onset of symptoms & COMPLETE recovery within 3-6 months
- severe cases of Bells Palsy may see ongoing changes in facial function for 12-18 months
- 70% of pts with Bell’s Palsy will FULLY recover
Define Synkinesis
abnormal involuntary mov’t that occurs with voluntary mov’t (e.g., eye involuntarily closing when the pt smiles)
- can occur with/following recovery from FNP
What could PT management include?
- pt education: explaining condition, recovery, eye care and self management strategies
- soft tissue massage: may also be included in self management
- facial neuromuscular retraining
➜facilitating the intended facial mov’t patterns and eliminating/decreasing unwanted patterns
➜exercises may include wrinkle of forehead, smile, snarl, lip pucker with varying amplitudes and speeds - functional retraining
- biofeedback: feedback using a mirror/EMG, while performing facial expressions
- electrotherapy
- taping
- acupuncture
Mary has has a L Facial Nerve Palsy, when she smiles her left eye twitches. What is the likely cause?
a) ataxia
b) flaccid paralysis
c) uthoff’s phenomenon
d) synkinesis
D) Synkinesis - involuntary mov’t that occurs with voluntary mov’t
Paul reports weakness on the L side of the face, on assessment, there is weakness only in the lower half of the L side of the face. Based on this info, which of the following is the most likely diagnosis?
a) Stroke
b) Bell’s palsy
c) Brachial plexus injury
d) Gullian-barre syndrome
A) stroke - only lower L side, forehead is spared
