Station 3.24: Facial nerve palsy

Question 1

Facial nerve palsy

What are the clinical signs of Facial nerve palsy?

Facial nerve palsy

Examine this patient’s cranial nerves. What is wrong?

Answer 1

• Unilateral facial droop, absent nasolabial fold and forehead creases
• Inability to raise the eyebrows (frontalis), screw the eyes up (orbicularis oculi) or smile (orbicularis oris)

Bell’s phenomenon: eyeball rolls upwards on attempted eye closure

Question 2

Facial nerve palsy

Level of the lesion?

Facial nerve palsy

Examine this patient’s cranial nerves. What is wrong?

Answer 2

Level of the lesion

Question 3

Discussion

Commonest cause is Bell’s palsy?

Facial nerve palsy

Examine this patient’s cranial nerves. What is wrong?

Answer 3

• Rapid onset (1–2 days)
• HSV‐1 has been implicated
• Induced swelling and compression of the nerve within the facial canal causes demyelination and temporary conduction block
• Treatment: prednisolone commenced within 72 hours of onset improves outcomes, plus aciclovir if severe
• Remember eye protection (artificial tears, tape eye closed at night)
• Prognosis: 70–80% make a full recovery; substantial minority have persistent facial weakness
• Pregnancy: Bell’s palsy is more common in pregnancy, and outcome may be worse

Question 4

Discussion

Other causes of a VII nerve palsy?

Facial nerve palsy

Examine this patient’s cranial nerves. What is wrong?

Answer 4

• Herpes zoster (Ramsay–Hunt syndrome)
• Mononeuropathy due to diabetes, sarcoidosis or Lyme disease
• Tumour/trauma
• MS/stroke

Question 5

Discussion

Causes of bilateral facial palsy?

Facial nerve palsy

Examine this patient’s cranial nerves. What is wrong?

Answer 5

• Guillain–Barré
• Myasthenia gravis
• Sarcoidosis
• Bilateral Bell’s palsy
• Lyme disease