Facial nerve palsy

Question 0

Causes of facial nerve palsies

Answer 0

Brainstem or skull base disease (tumours or meningeal disease)
Peripheral disease - herpes zoster, middle ear infection, parotid tumours, mastoiditis, sarcoid, lyme disease, guilain-Barre syndrome
Trauma
Idiopathic (bell’s palsy) - 75% of cases

Question 1

Clinical signs on facial nerve palsy

Answer 1

Flaccid paralysis of the muscles of facial expression
Widened palpebral aperture and impaired eyelid closure due to lower eyelid droop
Loss of wrinkles and nasolabial folds
LMN palsy will spare the forehead due to bilateral innervation

Question 2

Management of facial palsy

Answer 2

Check other cranial nerves, and for middle ear involvement
Refer for neuroimaging if there are other neurological signs or it hasn’t resolved after 3months
Refer to ophthalmology for corneal exposure/drying, epiphora or cosmetic concerns