Facial nerve palsy & Bell's palsy

Question 1

Facial nerve supplies?

Answer 1

1. face: muscles of facial expression
2. ear: nerve to stapedius
3. taste: supplies anterior two-thirds of tongue
4. tear: parasympathetic fibres to lacrimal glands, also salivary glands

Question 2

Causes of bilateral facial nerve palsy

Answer 2

1. sarcoidosis
2. Guillain-Barre syndrome
3. Lyme disease
4. bilateral acoustic neuromas
5. Bell’s palsy

Question 3

Causes of Unilateral facial nerve palsy

Answer 3

All the the bilateral causes PLUS:

>      Bell's palsy
>	Ramsay-Hunt syndrome
>	acoustic neuroma
>	parotid tumours
>	HIV
>	multiple sclerosis*
>	diabetes mellitus
>      Stroke

Question 4

Bell’s palsy

Answer 4

Defined as an acute, unilateral, idiopathic, facial nerve paralysis.

The aetiology is unknown although the role of the herpes simplex virus has been investigated previously.

Question 5

Epidemiology of Bell’s palsy

Answer 5

The peak incidence is 20-40 years, and the condition is more common in pregnant women.

Question 6

Features of Bell’s palsy (affecting both upper and lower motor nuclei)

Answer 6

Lower motor neuron facial nerve palsy - forehead affected

In contrast, an upper motor neuron lesion ‘spares’ the upper face

Question 7

Features of Bell’s palsy affecting lower motor nuclei

Answer 7

Lower motor neuron facial nerve palsy - forehead affected

Question 8

Features of Bell’s palsy affecting upper motor nuclei

Answer 8

Facial nerve palsy ‘spares’ the upper face

Question 9

What is the FOLLOW UP management of Bell’s palsy?

Answer 9

If the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT.

A referral to plastic surgery may be appropriate for patients with more long-standing weakness e.g. several months

Question 10

Treatment of Bell’s palsy

Answer 10

Treatment includes - No treatment, prednisolone only OR a combination of antivirals and prednisolone

Question 11

Treatment of facial nerve palsy

Answer 11

Corticosteroids, such as prednisone, are powerful anti-inflammatory agents.

Question 12

Ramsay Hunt syndrome

Answer 12

Occurs when a shingles outbreak affects the facial nerve near one of your ears. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear.

Question 13

Third nerve palsy symptoms

Answer 13

1. eye is deviated ‘down and out’
2. ptosis
3. pupil may be dilated

Question 14

Third nerve palsy causes

Answer 14

>	diabetes mellitus
>	vasculitis 
>	P. communicating artery aneurysm
>	cavernous sinus thrombosis
>	Weber's syndrome
>	amyloid, multiple sclerosis