Neurology 10 - Facial Nerve Palsy

Question 1

describe the journey of the facial nerve from brainstem

Answer 1

exits at cerebellopontine angle

passes through temporal bone and parotid gland

divides into 5 branches

temporal 
zygomatic
buccal
marginal mandibular
cervical

Question 2

function and supply of facial nerve

Answer 2

motor: muscles of facial expression, stapedius, posterial digastric / stylohyoid / platysma neck muscles
sensory: taste in anterior third of tongue
parasympathetic: for salivary glands and lacrimal gland

Question 3

upper motor neurone face lesion

Answer 3

forehead is spared - MORE worrying if can move forehead completely (stroke)

Question 4

lower motor neurone face lesion

Answer 4

forehead is NOT spared - can’t move on affected side (usually Bell’s palsy)

Question 5

Bell’s palsy

Answer 5

fairly common
unilateral lower motor neurone facial nerve palsy

most recover in weeks
some left with a bit of weakeness

Question 6

treatment Bell’s palsy

Answer 6

within 72 hrs of symptoms

give 50mg pred for 10 days

lubricating eye drops

ophthalmology check for exposure keratopathy

Question 7

define Ramsay Hunt syndrome

Answer 7

caused by herpes zoster

painful and tender vesicular rash in ear cannal, around ear and on front of tongue

give pred + acyclovir
eye drops

Question 8

vesicular rash around ear and facial nerve palsy

Answer 8

think Ramsay Hunt syndrome

Question 9

DDx lower motor neurone facial nerve palsy

Answer 9

infection (otitis media, Lyme’s)
systemic (diabetes, sarcoid, GBS)
tumours (acoustic neuroma, parotid tumours)
trauma (base of skull #, surgical)