Facial palsy

Question 1

What are intracranial causes?

Answer 1

brainstem tumours
strokes
polio
MS
cerebellopontine angle lesions - acoustic neuroma, meningitis

Question 2

What are intra temporal causes?

Answer 2

otitis media
Ramsay hunt syndrome
cholesteatoma

Question 3

what are infra temporal causes?

Answer 3

parotid tumours

trauma

Question 4

What are other causes of facial nerve palsy?

Answer 4

sarcoidosis
Guillain-barre
lyme disease
herpes
Bells palsy 
diabetes

Question 5

Explain the course of the facial nerve

Answer 5

arises in medulla
emerges between pons and medulla
passes through the posterior fossa
runs through the middle ear then out the stylomastoid foramen to pass into the parotid

Question 6

What is the function of the facial nerve?

Answer 6

Supply - ‘face, ear, taste, tear’

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

Question 7

How do LMN lesions differ to UMN lesions?

Answer 7

UMN - spares forehead

LMN - affects all facial muscles

Question 8

How would u examine and test an individual w a facial nerve palsy?

Answer 8

examine parotid
examine ear - exclude cholesteatoma
Temporal bone CT?

Question 9

What is ramsay hunt syndrome? what are the features?

Answer 9

shingles affecting the facial nerve 
features:
auricular pain 
facial nerve palsy
vesicular rash around the ear
vertigo, tinnitus

Question 10

What is the management of Ramsay hunt syndrome?

Answer 10

oral acyclovir and CS

Question 11

What is Bells palsy?

Answer 11

type of facial paralysis that results in an inability to control the facial muscles on the affected side

Question 12

What causes bells palsy?

Answer 12

unknown but pathology is inflammatory oedema from entrapment of the facial nerve in the narrow bony facial canal
- may be associated w HSV

Question 13

How does a pt present w bells palsy?

Answer 13

Abrupt onset
LMN facial nerve palsy - forehead affect, mouth sags, dribbles, impaired brow wrinkling, lid closure, cheek pouting, taste and speech
Post auricular pain (may precede paralysis)

Question 14

What is the rx of bells palsy?

Answer 14

Prednisolone if given w/in 72 hrs
Eye care - artificial tears, tape closed during sleep
High dose acyclovir or valaciclovir may be indicated

Question 15

What is the prognosis of bells palsy?

Answer 15

third get full recovery,
third have incomplete
third have permanent neuro + cosmetic abnormalities

Question 16

When is acyclovir indicated in the rx of bells palsy?

Answer 16

if preceding pain in the ear, stiff neck or a reddish auricle as this indicates that the cause is likely to be HSV