Facial Nerve Palsy

Posted by e-Medical PPT Sunday, November 7, 2010
Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve.The most common is Bell's palsy, an idiopathic disease that may only be diagnosed by exclusion.
Bell's palsy is the most common cause of acute facial nerve paralysis . Previously considered idiopathic, it has been recently linked to herpes simplex infection. Another more severe form of facial palsy, called Ramsay-Hunt syndrome, is linked to herpes zoster infection of the facial nerve. Other, less common, etiologies are Lyme disease polio, TB.
Bell's palsy is an exclusion diagnosis. Some factors that tend to rule out Bell's palsy include:
   1. Recurrent paralysis
   2. Slowly progressive paralysis (The onset of Bell's palsy is very sudden, usually within 24 hours all the symptoms have been manifested)
   3. Twitching
   4. Associated symptoms (either cochlear or neurologic)
Bell's palsy is believed in the most recent studies to be due to herpes virus. Other proposed etiologies include vascular problems in the inner ear. Treatment includes steroids and antivirals.
Ramsay Hunt syndrome type II or Herpes zoster oticus is essentially a herpes zoster infection that affects cranial nerves VII (facial nerve) and VIII (vestibulocochlear nerve). Patients present with facial paralysis, ear pain, vesicles, sensorineural hearing loss, and vertigo. Management includes Antiviral drugs and oral steroids.
Physical trauma, especially fractures of the temporal bone, may also cause acute facial nerve paralysis.Transverse fractures in the horizontal plane present the highest likelihood of facial paralysis (40-50%). Patients may also present with hemotympanum,sensory deafness, and vertigo.

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