Facial Paralysis Flashcards
1
Q
In traumatic/iatrogenic cases of facial paralysis in which
distal nerve stumps are available, nerve repair or transfer
is best performed within 72 hours of injury, prior to deple*
tion of neurotransmitter in the distal stump
A
T
2
Q
Local muscle transfers reliably improve resting tone and appearance in children only.
A
F Local muscle transfers reliably improve resting tone and appearance (in both children and adults)
3
Q
In Local muscle transfers the ability to animate remains variable
and often inferior to that provided by free functional muscle transfer
A
T
4
Q
Both nerve to masseter and cross-facial nerve grafts can be
used with free functional muscle transfers to generate pow·
erful, reliable smile
A
T
5
Q
the only use of nerve to masseter can lead to a smile under emotional control
A
F only use of cross-facial nerve grafts can lead to a smile under emotional control
6
Q
most common diagnosis for facial paralysis
in adults
A
Bell palsy
7
Q
A common cause of paralysis in children
A
In children, paraly·
sis is more often due to infection or trauma
8
Q
The branchial motor (from the motor nucleus) supplies anterior belly
of the digastric
A
F Posterior belly of digastric
9
Q
The submandibular and sublingual glands receive fibers via he chorda tympani
A
T
10
Q
The lacrimal gland and nasal mucosa receive
fibers via the pterygopalatine ganglion
A
T
11
Q
Input to the motor nucleus for upper facial function is
from bilateral motor cortices
A
T
12
Q
Control of lower facial function comes
from only the contralateral motor cortex
A
T
13
Q
Distal to the motor nucleus, lesions of the
facial nerve result in paralysis of all ipsilateral distributions
A
T
14
Q
the motor component of the facial nerve runs together with the visceral motor, general sensory, and special sensory fibers
A
F motor component of the facial nerve runs separately from the visceral motor, general sensory, and special sensory fibers
15
Q
At the level of
the geniculate ganglion, the nervus intermedius and the motor component join together
A
T
16
Q
Within this segment of geniculate ganglion , the facial nerve gives off three
branches.
A
T
17
Q
The most common site at risk of compression in facial nevre course is
A
The diameter of the labyrinthine segment is small compared
with that of the facial nerve, placing the nerve at risk for compression.
18
Q
Branched of the facial nerve at the mastoid
A
nerve to the stapedius, the sensory branch to the external auditory
canal, and the chorda tympani
19
Q
At the end of the mastoid segment, the nerve exits the skull base through the stylomastoid foramen
A
T
20
Q
In adults, the facial nerve is more susceptible to trauma at the exit of stylomastoid foramen
A
F In adults, the facial nerve is relatively protected by the mastoid tip,
tympanic ring, and mandibular ramus, as it emerges from the stylomastoid foramen. In children, it is more superficial, lacking this bony
protection, and thus more susceptible to trauma in this area
21
Q
Facial nerve located medial to the tympanomastoid suture
A
T
22
Q
running lateral to the styloid process
A
T
23
Q
relation to the tragal pointer (to
which it lies 1 cm deep, and just inferomedially)
A
T
24
Q
The facial nerve gives branches of the stylohyoid muscle and the posterior belly of the digastric muscle and the occipitalis and the auricular
muscles after passing from the earlobe.
A
F Prior to coursing anteriorly around the earlobe
25
congenital palsies such as Mobius syndrome the patients are unable to dampen the noise T F
F Cell bodies for Nerve to stapedius is not located in the motor nucleus and therefore
the function is spared in congenital palsies such as Mobius syndrome.
26
What is Hitselberger's sign?
hypesthesia of the external auditory canal (i.e., from tumors
generating a mass effect on the sensory fibers of the facial nerve)
27
facial nerve enters the parotid gland, where it
travels between the deep and superficial lobes
T
28
Within the gland,
the nerve divides into two main branches-the temporofacial
superiorly and the cervicofacial inferiorly
T
29
50% of the population, the lower zygomatic branch joins with buccal
branches to create a zygomaticobuccal plexus
F 10% of the population, the lower zygomatic branch joins with buccal
branches to create a zygomaticobuccal plexus
30
The buccal nerve runs inferior to the parotid duct along it course T F
F Can be superior or inferior or flank the duct
31
How you can locate the zygomaticobuccal branch to the zygomatic major
landmark - the midpoint of the line drawn from the root of the helix to the oral commissure. Zuker's point.
will be
found within 2.3 mm of this location.
32
The marginal mandibular nerves run superficial to the facial vessels
T
33
Cervical Division exit with multiple branched from paroted
F Unlike the other divisions, which exist as multiple branches in the
face, generally only one cervical branch is present
34
,Bell palsy is a diagnosis of exclusion
T
35
Bell palsy is less likely to be the diagnosis in the setting
of........
bilateral palsy, paralysis of insidious onset, or palsy that is waxing and waning
36
In bells palsy most patients begin to
experience recovery within 3 weeks of symptom onset
T
37
Proximal branches are at risk during facial cosmetic procedures and treatment
of facial fractures
F terminal
branches are at risk during facial cosmetic procedures and treatment
of facial fractures
38
Paralysis following acute otitis media is a particularly
common finding in pediatric patients
T
39
C is a common
diagnosis in bilateral paralysis.
T
40
Most common causes of bilateral infectious causes of facial palsy
Lym disease and HIV
41
ongenital facial paralysis accounts for a larger portion
of diagnoses in children compared with adults
T
42
The most common cause of con_genital facial paralysis is hemifacial microsomia
F The most common cause of con_genital facial paralysis is birth
trauma
43
Congenital birth trauma from the use of forceps. Often, these cases resolve fully by 1 month
T
44
bilateral
paralysis most commonly has no an identifiable cause
F bilateral
paralysis most commonly has an identifiable cause
45
the most common congenital cause of bilateral paralysis.
Mobius syndrome
46
The most common nerves involved in mobius syndrom?
sixth (abducens)
and seventh (facial). The hypoglossal nerve (cranial nerve [CN] XII) is
the third most commonly affected
47
Mobius syndrom is always bilateral
F may be unilateral.
48
the trigeminal nerve is responsible for the afferent component of blink reflex
T
49
Risk of corneal damage is increased with which condition
in patients who lack a Bell
phenomenon
and in patients who have concomitant injury to the ophthalmic division of the trigeminal nerve (responsible for corneal sensation and epithelial maintenance)
50
In the
setting of unilateral facial paralysis, this external nasal valve collapse
is accentuated by deviation of the nasal tip to the unaffected side,
T , further obstructing airflow
51
Synkinesis causes
results from aberrant axonal
sprouting into incorrect muscles, as nerves regenerate following
paralysis. It may also be related to central changes that take place as
reinnervation occurs
52
Electrodiagnostic studies are recommended in facial palsy
Electrodiagnostic studies are not commonly utilized, but for select
patients may provide information regarding expected recovery
53
conservative (especially
physical therapy) or medical approaches are often used either as sole
treatment or as adjuncts to surgery.
T
54
The draw back of House-Brackmann scale
does not differentiate between dysfunction of specific
divisions of the faci_al nerve
has little ability to describe preand postoperative movement
55
All patients, regardless of their need for
surgical intervention, should undergo physical therapy to maximize
their functional recovery
T
56
Surgical intervention may be pursued when facial paralysis is congenital, secondary to trauma or iatrogenic injury
T
57
Static procedures generate new movement under emotional and/or volitional control.
F Dynamic procedures generate new movement under emotional and/or volitional control.
58
Both the upper and lower eyelids may be operated on simultaneously.
t
59
Static surgery can be done for children ?
F These techniques are avoided in the pediatric population because of the success
of dynamic procedures in children, and in whom the ability to emote
is particularly important for social integration
60
Contralateral Defunctioning s are commonly used with good results in
CULLP and in adult patients with acquired unilateral lip depressor
dysfunction.
T
61
within 6-12 months of injury direct transfer from physically closer nerves
(i.e., nerve to masseter) is favored
F . Twelve to eighteen
months following injury, direct transfer from physically closer nerves
(i.e., nerve to masseter) is favored to shorten time to reinnervation
62
If a single donor
nerve is used to reinnervate multiple functions (i.e., smile and blink),
synkinesis results
T
63
When cross-facial nerve grafting is unavailable (i.e., bilateral
palsy) Cranial
nerve V (specifically, nerve to masseter) is often a favorable choice
because of proximity to targets and reliable anatomy
T
64
When I need to consider muscle transfere ?
When viable mimetic musculature is not available for reinnervation
65
Local muscle transfer most commonly reroutes all or part of the
temporalis and/or masseter for generation of smile and/or blink
T
66
masseter transfers reliably improve static
tone, but results for animation are less consistent.
T
67
A functional smile can not be achieved with masseter muscle
F Functional smile
may be achieved, but the vector of pull through many techniques of
transfer leads to a smile of unnatural appearance
68
temporalis transfer reliably provides static support
T
69
Draw back of temporalis transfere?
temporal hollowing can occur
excursion is variable
Temporalis muscle maybe not be viable in some patient who underwent neurosurgical intervention through temporal region
70
Contralateral facial
nerve (via cross-facial nerve graft) advantages
■ The only donor capable of generating emotional control
of smile
■ Capable of generating good excursion in a smile
■ Can use corresponding contralateral branches for blink
■ No significant donor deficit
71
in patients with Mobius
syndrome we can not uses nerve to masseter as nerve graft
F Reliable donor (even in patients with Mobius
syndrome)
72
Nerve to masseter Capable of generating good excursion in smile (can
show greater excursion than that achieved via crossfacial nerve grafting)
T
73
Draw back of the nerve to masseter
Volitional rather than emotional control
74
Hypoglossal nerve transfer disadvantage
■ Third most commonly affected cranial nerve in Mobius
syndrome-unreliable source of innervation in these patients
and use may impair speech and ability to swallow
■ Volitional rather than emotional control
75
Free functional muscle transfer is often considered the standard for
smile reanimation, particularly in children
T
76
these are
nearly always the procedure of choice for reanimation because of reliability in the younger population.
T
77
Free functional muscle transfer options exist for both upper and lower facial reanimation
T
78
emotional control of a free muscle can be achieved either with the use of nerve to masseter or contralateral facial nerves donor
F emotional control of a free muscle can be achieved only through use of the
contralateral facial nerveas donor
79
nerve to masseter is almost always unaffected in patients with Mobius
syndrome
T
80
greater commissure excursion resulting from use of
nerve to masseter as compared with cross-facial nerve grafting with free muscle motor units transfer
T
81
Extensor carpi radialis brevis as Muscles Free Functional
Transfers Results often inferior to use of other muscles
T
82
Local muscle transfers Has the ability to animate remains variable
and often inferior to that provided by free functional muscle transfer
T
83
Branchial motor (from the motor nucleus): Accounts for most of
the axons of the facial nerve. Innervates the mimetic musculature
of the face as well as the stylohyoid, stapedius, and posterior belly
of the digastric
T
84
Special sensory of the facial nerve (solitary nucleus): Contributes taste to the anterior
two-thirds of the tongue (via the chorda tympani).
T
85
, upper motor
neuronlesions generallylead to contralaterallower facial paralysiswith
preserved forehead function
T
86
The intratemporal course of the facial nerve is divided into three segments . The most proximal is the labyrinthine,
T
87
labyrinthine, contains taste and sensory nerve cell bodies
T
88
The labyrinthine and tympanic segments
meet at an acute angle that is a common location for shearing injuries
to the nerve in trauma involving the temporal bone
T
89
the lower zygomatic branch joins with buccal
branches to create a zygomaticobuccal plexus
T
90
The marginal mandibular division runs as two to four branches
t
91
only one cervical branch is present. It exits the parotid
anterior to the angle of the mandible and does not divide until it
passes inferior to the mandibular border
T
92
The mainstay oftreatment of bells palsy is a course ofcorticosteroids (most effective when instituted within 24 hours of symptom onset) and antivirals,
T
93
some may not see signs ofreturning function for up to 3 to 6 months
T
94
Approximately 75% of patients experience full resolution of symptoms
T
95
head and neck malignancies,
and iatrogenic injuries to be the most common etiologies after Bell
palsy
T
96
Ramsay Hunt Syndrome
Varicella zoster virus-associated facial paralysis
, sudden onset
paralysis, hearing loss, severe pain, ±vesicular
rash
97
Lyme disease is a common
diagnosis in bilateral paralysis
T
98
Idiopathic cause of facial palsy
Bell palsy (frequently associated with pregnancy,
at least partial recovery expected)
Melkersson-Rosenthal syndrome (recurrent facial paralysis, orofacial swelling, fissured tongue)
99
HIV often bilateral palsy
T
100
HSV, EBV, and VZV can cause Facial palsy
T
101
Rickettsial
Lyme disease (bilateral)
T
102
Autoimmune causes od facial palsy Guillain-Barre syndrome (bilateral)
T
103
Tumour causes of facial palsy
Acoustic neuroma (bilateral in NF2),
meningioma, cerebellopontine tumors
(intracranial)
Cholesteatoma (intratemporal)
Parotid mass (extracranial)
104
Neuromuscular causes of facial palsy
Myesthenia gravis
105
Autoimmune diseases generally lead to Unilateral
Autoimmune diseases generally lead to bilateral
106
In CULLP, also referred to as asymmetric crying facies,
there is generally no significant asymmetry noticed at rest, but
obvious deficit of lower lip depression on the affected side in crying
T
107
Syndromic sources of paralysis include
hemifacial microsomia (most commonly) and Mobius syndrome.
T
108
Lagophthalmos results from abnormalities of
both the upper and lower eyelids
T
109
the levator palpebrae superioris (innervated by the oculomotor nerve)
T
110
facial divisions of the facial nerve
are responsible for the efferent component of the blink reflex
T
111
Eating difficulties arise in part from denervation of the buccinator which impairs control of food boluses during chewing can lead
to sequestration of food into the buccal sulcus
T
112
Nasal airway obstruction causes
results in part from denervation of nasalis and levator labii superioris
alequae nasi, which may lead to collapse of the affected ala
113
electrodiagnostics are not generally used in pediatrics)
T
114
psychologic and social work services often play a central role in the care ofpatients.
T
115
Management of synkinesis requires denervating the muscle that activates inappropriately or retraining it to inhibit unwanted movement.
T
116
The choice of procedure depends on specific functional deficits, patient desires, and suitability of the patient to undergo various surgeries
T
117
static procedures in the lower face cannot generate
smile, they improve appearance and oral competence.
T
118
Dry mouth (may indicate proximal facial nerve injury)
T
119
Lower lid treatment
■ Canthoplasty/canthopexy (mild to
moderate deformity)
■ Fascia! slings (severe deformity)
■ Tarsorrhaphy (when other techniques fail
to protect the cornea)
120
Nasal airway collapse treatment
Alar base fixation and periosteal anchoring
(mild to moderate deformity)
Alar base elevation and support via tendon
sling (severe deformity)
121
contralateral facial nerve branch. is favored
when performed within 6-12 months of injury
T
122
For smile, transfer may performed through an intraoral approach ( Masseter muscle)
T
123
disinserts the temporalis from the coronoid and transfer of the insertion
to the commissure
T
124
Spinal accessory can used as DONOR NERVES FOR NERVE TRANSFER AND INNERVATION OF FREE FUNCTIONAL MUSCLE TRANSFERS
T ■ Distance from target. often necessitates use ofintervening
nerve graft
■ Volitional rather than emotional control
125
Free functional muscle transfer is often considered the standard for
smile reanimation, particularly in children
T
126
Free functional muscle transfer produce superior commissure excursion (in terms of magnitude and
direction) compared with local muscle transfer
T
127
Options exist for both upper and lower facial reanimation.
T
128
options exist for blink reinnervation
most commonly either a segment of gracilis or a slip of platysma.
129
Functional muscle transfer linked to the nerve to the masseter Unlike with cross-facial nerve grafting, reanimation is accomplished in
a single stage
T
130
The nerve to masseter is large and can donate more axons to the recipient free muscle than can a cross-facial nerve graft
T This may manifest
functionally as greater commissure excursion resulting from use of
nerve to masseter as compared with cross-facial nerve grafting
131
the first muscle transfer is not
performed prior to the age of4 years
T
132
Reanimation can be performed either simultaneously or staged (one
side at a time, spaced 3 months apart)
T
