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HESP632 Final > Facial Nerve Tumors > Flashcards

Facial Nerve Tumors Flashcards

1
Q

What are the 4 components of the facial nerve?

A
  1. Branchial motor
  2. Visceral motor
  3. Special sensory
  4. General sensory
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2
Q

Describe the branchial motor component of the facial nerve.

A
  • Supplies the muscles of facial expression
  • Posterior belly of digastic muscle
  • Styohyoid
  • Stapedius
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3
Q

Describe the visceral motor component of the facial nerve.

A
  • Parasympathetic innervation of the lacrimal, submandibular, and sublingual glands
  • As well as mucous membranes of nasopharynx, hard and soft palate
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4
Q

Describe the special sensory component of the facial nerve.

A
  • Taste sensation from the anterior 2/3 of tongue

- Hard and soft palates

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5
Q

Describe the general sensory component of the facial nerve.

A

-General sensation from the skin of the concha of the auricle and from a small area behind the ear

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6
Q

What are the motor branches of the facial nerve?

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical
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7
Q

Describe differential diagnosis for acute facial nerve paralysis.

A
  • Polyneuritis
  • Trauma (i.e. temporal bone, birth traum)
  • Otitis media
  • Sarcoiditis
  • Malkersson-Rosenthal
  • Neurologic disorders (i.e. HIV)
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8
Q

What are examples of polyneuritis?

A
  • Bell’s palsy
  • Herpes zoster
  • Guillan Barre syndrome
  • Autoimmune disease
  • Lyme disease
  • HIV
  • Kawasaki disease
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9
Q

Describe differential diagnosis for chronic or progressive facial nerve paralysis.

A
  • Malignancies (i.e. metastatic tumor)
  • Benign tumors (i.e. schwannoma, glomus tumor)
  • Cholesteatoma
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10
Q

Describe the examination of patient with facial paralysis/paresis.

A

-History (time of onset, precipitating factors, speed of progression, associated symptoms)
-PE (House-Brackmann classifications)
-Topodiagnostic tests
-Electrophysiologic tests
-Lab tests PRN
Imaging

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11
Q

Describe the House-Brackmann Scale.

A
  • Grading of CN VII function
  • Grade I: normal
  • Grade II: mild
  • Grade III: moderate
  • Grade IV: moderately-severe
  • Grade V: severe
  • Grade VI: total paralysis
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12
Q

Describe Grade II of the House-Brackmann Scale

A
  • Mild
  • Gross: slight weakness noticeable on close inspection
  • At rest: normal symmetry and tone
  • Motion:
  • Forehead: moderate to good
  • Eye: complete closure with minimum effort
  • Mouth: slight asymmetry
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13
Q

Describe Grade III of House-Brackmann Scale.

A
  • Moderate
  • Gross: obvious but not disfiguring asymmetry; may have hemifacial spasm
  • At rest: normal symmetry and tone
  • Motion:
  • Forehead: slight to moderate movement
  • Eye: complete closure with effort
  • Mouth: slightly weak with maximum effort
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14
Q

Describe Grade IV of House-Brackmann Scale.

A
  • Moderately-severe
  • Gross: obvious weakness and/or disfiguring asymmetry
  • At rest: normal symmetry and tome
  • Motion:
  • Forehead: no movement
  • Eye: incomplete closure
  • Mouth: asymmetric with maximum effort
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15
Q

Describe Grade V of House-Brackmann Scale.

A
  • Severe
  • Gross: only barely perceptible motion
  • At rest: asymmetry
  • Motion:
  • Forehead: no movement
  • Eye: incomplete closure
  • Mouth: slight movement
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16
Q

What are some topodiagnostic tests of facial nerve function?

A
  • Schirmer’s test of lacrimal function
  • Stapedial reflex
  • Electrogustometry
  • Salivary flow
17
Q

What are some electrodiagnostic tests of facial nerve function?

A
  • Nerve excitability test
  • Maximum excitability test
  • Electromyography (EMG)
  • Electroneuronography (ENoG)
18
Q

What is the nerve excitability test?

A
  • Transcutaneous stimuli delivered over stylomastoid foramen

- Electrical pulses delivered at increasing current levels until facial twitch is noticed

19
Q

What is the maximum excitability test?

A
  • Transcutaneous stimuli looking for twitch

- Increase current to get a maximum response

20
Q

What is electromyography (EMG)?

A
  • Recording of spontaneous and voluntary muscle potentials
  • Needle electrodes in facial muscle groups
  • May help to predict recovery
21
Q

What is electroneuronography (ENoG)?

A
  • Stimulating electrodes deliver suprathreshold electrical stimuli
  • Recording electrode measures compound muscle action potential
  • Reduction in response amplitude reflects number of damaged motor fibers
  • Best 3 days to 3 weeks
22
Q

What is Bell’s Palsy?

A
  • Most common acute mono-neuropathy or disorder affecting a single nerve
  • Most common diagnosis associated with facial nerve paresis or paralysis of unknown cause
  • Causes partial or complete inability to voluntary move facial muscles on the affected side of the face
23
Q

What may result from facial paresis/paralysis of Bell’s Palsy?

A
  • Significant oral incompetence
  • Eye injury
  • Long term poor outcomes, which can be devastating to the patient
24
Q

Describe the diagnosis of Bell’s Palsy.

A
  • Diagnosis of exclusion
  • Not every pt with facial paresis/paralysis will have Bell’s Palsy
  • Rapid exclusion (<72 hours)
  • Bilateral is RARE
  • Currently, cause is unknown
  • Can occur in anyone, but is most common in 15-45 y/o and those with risk factors
25
Q

Describe the issues of testing/treating Bell’s Palsy.

A
  • Variations in care; controversy over best treatment options
  • Numerous tests available; many are of questionable benefit
  • Typically, self-limiting
26
Q

What are risk-factors for Bell’s Palsy?

A
  • Pregnancy
  • Severe pre-eclampsia
  • Obesity
  • Hypertension and chronic hypertension
  • Diabetes
  • Upper respiratory ailments
27
Q

Describe the prognosis for Bell’s Palsy.

A
  • Majority have spontaneous, good recovery at 3-6 months
  • Best prognosis: never Grade VI, signs of recovery at 2 months, EMG evidence of voluntary activity, present acoustic reflex, <90 % degeneration on ENoG at 2 week point
  • Worst prognosis: age 65+, diabetes, >90% degeneration on ENoG at 2 week point
28
Q

Describe eye care for Bell’s Palsy.

A
  • Very important for Grade III or worse
  • Drying of eye secondary to decreased eye closure/lacrimation, leading to keratopathy and breakdown of the cornea
  • Daytime: artificial tears every 2 hours
  • Nighttime: opthalmic ointment and moisture chamber over eye
  • Temporary tarsorrpaphy or gold weight
29
Q

Describe medical treatment for Bell’s Palsy.

A
  • Steroid Rx should be given in 72 hours for 16;0+ (i.e. prednisone)
  • Antiviral therapy used in combination with oral steroid by some
30
Q

Describe surgical treatment of Bell’s Palsy.

A
  • Facial nerve decompression (transmastoid, MF)
  • No clear evidence of efficacy (good outcomes for pts with incomplete paralysis, small Ns, variable surgical approaches, lack of efficacy compared to natural hx)
31
Q

What is the presentation of Herpes Zoster Oticus aka Ramsay Hunt Syndrome?

A
  • Severe pain
  • Vesicles in cocha
  • Severe facial paralysis (Grades V and VI)
  • Frequently involves CN VIII giving hearing loss and vertigo
  • May involve CN Ix, X, XI, and XII
32
Q

What is the cause of Herpes Zoster Oticus?

A

-Varicella zoster virus

33
Q

What is the prognosis for Herpes Zoster Oticus?

A
  • Spontaneous recovery of CN VII function 22-31%

- ENoG prognostication-not so good

34
Q

What is the presentation of facial neuroma?

A
  • Facial weakness
  • Hearing loss (50%)
  • 10-15% have: tinnitus, ear canal mass, pain, vestibular sx, otorrhea

HESP632 Final (7 decks)

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