Facial palsy Flashcards

1
Q

where does the facial nerve arise in the brainstem

A

pons -motor and sensory

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2
Q

where does the facial nerve exit the brainstem

A

pontomedullary junction

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3
Q

where does the facial nerve exit through the skull

A

posterior fossa

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4
Q

where does the facial nerve go once out the posterior fossa 3

A

through the middle ear -> emerges through the stylomastoid foramen -> passes into the parotid

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5
Q

state the three intracranaial branches of the faicla nerve

A

greater superfical petrosal nerve

branch to stapedius

chorda tympani

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6
Q

function of greater superfical petrosal nerve (intercraial branch of facial nerve)

A

lacrimation

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7
Q

presentation if lesion of stapedius branch of the facial nerve

A

hyperacusis

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8
Q

function of chorda tympani (intercraial branch of facial nerve)

A

supply taster to anterior 2/3 of tounge

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9
Q

function of all extracrainial branches of facial nerve 1

A

motor

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10
Q

state the extracranial branches of facial nerve 7

A

posterior auricular nerve

branch to posteiror belly of digastric muscle and stylohyoid msucle

5 major branches within parotid
-temporal
-zygomatic
-buccal
-arginal madnibular
-cerivcal

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11
Q

how can causes of facial palsy be split 4

A

intracranial

intratemproal

infratemporal

others

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12
Q

intracranial causes of facial palsy 5

A

brainstem tumour

stroke

polio

MS

cerebellopontine angle lesions (acoustic neuroma, meningitis)

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13
Q

intratemporal causes of facial palsy 3

A

otitis media

ramsay hunt syndrome

cholesteatoma

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14
Q

defnie ramsay hunt syndrome

A

Ramsay Hunt syndrome (herpes zoster oticus) 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

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15
Q

infratemporal causes of facial palsy 2

A

parotid tumour

trauma leading to complete palsy

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16
Q

investigation if complete palsy of facial nerve

A

URGENT CT

  • if nerve cnaal disrupted- surgical exploration advised
17
Q

other causes of facial palsy 4

A

lyme disease

sarcoid

diabeetes

bells palsy

18
Q

signs of facial palsy from lower motor neurone lesion 1

A

Lower motor neuron lesion can paralyse all of one side of the face

19
Q

signs of uper motor neuron lesion in facial palsy

A

can be caused by CVA
-patient may still be able. to work forehead muslces and close both eyes -THESES ARE BILATERALLY REPRESTENTED

20
Q

tests for facial nerve palsy 4

A

ESR

lyme disease serology

examine parotid to exclude cholesteatoma and ramsay hunt syndrome

ask about head trauma

21
Q

imaging for facial nerve palsy (1) and what to look for 4

A

MRI

-space occupying lesion
-CVA
-MS
-temporal bone fracture

22
Q

define bells pasly

A

idiopathic facial palsy

-cause of 70% of fical palsies

-unilateral lower motor neuron facial palsy

-partly DIAGNOSIS OF EXCLUSION

23
Q

risk factors for bells palsy

A

increased risk in pregnancy (x3)

increased risk in diabetes (x5)

24
Q

cause of bells palsy

A

unclear
-due to inflammatory oedema from entrapment of facial nerve in narrow bony facial canal

25
Q

presentation of bells palsy 5

A

onset abrupt usually after sleep

complete weakness at 24-72hr

mouth sags + dribbling

water (or dry) eyes

impaired facial nerve exam- all movements

taste speech and hyperacusisi from stapedius palsy can be seen

26
Q

treatment for bells palsy 2

A

prednisolone- if given within 72hrs of onset

keep eye well lubricated

27
Q

when to refer bells palsy

A

any doubt on diagnosis

recurrent bells palsy

bilateral bells palsy

paralysis shows no improvment after 1 month

28
Q

causes of bilateral bells palsy 7

A

lyme disesae

guillain-barre syndrome

leukaemia

sarcoidosis

EBV

trauma

myasthenia gravis