Facial paralysis

Question 1

What are some causes of facial paralysis? (4)

Answer 1

1. spontaneous
2. trauma
3. surgery
4. tumors of pinna, parotid gland or skull base

Question 2

Paralysis of (central/peripheral) portion of the facial nerve affects all divisions of the nerve

Answer 2

peripheral

Question 3

Paralysis of (central/peripheral) portion of the facial nerve spares the forehead

Answer 3

central - lesion of the supranuclear tracts

Question 4

How is facial paralysis graded? What is considered normal vs flaccid complete paralysis?

Answer 4

1-6
1 = normal
6 = flaccid complete paralysis

Question 5

What are the 6 major branches of the facial nerve?

Answer 5

1. Temporal
2. Zygomatic
3. Buccal
4. Mandibular
5. Cervical
6. Posterior Auricular

Question 6

What is it called when a patient presents with unilateral facial nerve paralysis that is, by definition, idiopathic

Answer 6

Bell’s palsy

Question 7

PCR has shown Bell’s palsy is related to what type of infection in most cases?

Answer 7

Herpetic infection

Question 8

Is the onset and recovery of Bell’s palsy fast or slow?

Answer 8

Onset fast (sudden)
Recovery = gradual, but spontaneous expected in >85%

Question 9

What meds can inc freq of complete recovery in Bell’s palsy?

Answer 9

Prednisone (oral steroid)

Antiviral

Question 10

If facial paralysis has a gradual onset and does not begin to recover by 6-8 weeks, or recurrent symptoms on the same side occur, this suggests what? How can this be evaluated?

Answer 10

Tumor (e.g. facial nerve neuroma, parotid gland malignancy, cerebello-pontine angle tumor
Gadolinium-enhanced MRI

Question 11

What syndrome causes facial nerve paralysis and is accompanied by severe pain and a vesicular eruption in the external auditory canal and auricle in the distribution of the facial nerve

Answer 11

Ramsay-Hunt Syndrome

Question 12

Which has a better prognosis, Bell’s palsy or Ramsay-Hunt synd?

Answer 12

Bell’s

Question 13

This syndrome is related to reactivation of herpes zoster in the geniculate ganglion. What’s the std tx?

Answer 13

Ramsay Hunt’s syndrome

Medical therapy with antiviral agents and oral steroids

Question 14

Temporal bone fractures may injury (transect or stretch) what nerve?

Answer 14

Facial nerve

Question 15

If the facial nerve is not transected and the nerve swells, it can impeded ___ flow and create a conduction block. Facial paralysis can take up to ___ hrs to develop

Answer 15

Axoplasmic

72

Question 16

What can be done to assess the facial nerve along its intratemporal course?

Answer 16

electrical testing and high-resolution CT scanning of the temporal bone

Question 17

When would you reanastomose or use an interpositional graft with a greater auricular/sural nerve for the facial nerve transmastoid/intercranially?

Answer 17

If it’s impaled by a bony spicule

Question 18

If the cochlea or balance organs are injured in temporal bone trauma, what type of hearing problem would result?

Answer 18

Complete SNHL

Question 19

If the middle ear or ear canal are injured in temporal bone trauma, what type of hearing problem would result?

Answer 19

conductive hearing loss may occur secondary to a middle ear blood collection (hemotympanum)

Question 20

If the ossicular chain is discontinuous, or a TM perforation occurs, what type of hearing problem would result?

Answer 20

Conductive hearing loss

Question 21

How does the facial nerve play a key role in the function of the eye?

Answer 21

Help with eyelid closure –> keeps cornea moist (blinks sweeps tears over the cornea, and eyelid closure at night prevents the cornea from drying)
Prevents foreign bodies from injuring the cornea

Question 22

What is a consequence of dry corneas?

Answer 22

Corneal ulcerations, pain, scarring, permanent changes in vision

Question 23

How to treat eyelid closure dysfunction due to facial nerve paralysis?

Answer 23

1. artificial tears
2. sleep with plastic moisture chamber
3. surgery - gold weight on upper eyelid to pull lid down