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| | __NOTOC__ |
| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
| | Image = Paralisis_facialMOCHE.jpg | | | Image = Paralisis_facialMOCHE.jpg |
| | Caption = Moche. Culture Representation of Facial Paralysis. 300 A.D. Larco Museum Collection, Lima, Peru. | | | Caption = Moche. Culture Representation of Facial Paralysis. 300 A.D. Larco Museum Collection, Lima, Peru. |
| | DiseasesDB =
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| | Width = 220px
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| | ICD10 =
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| | ICD9 = {{ICD9|351}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = plastic
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| | eMedicineTopic = 522
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| | MeshID = D005158
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| }} | | }} |
| {{SI}}
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| {{CMG}} | | {{CMG}} |
| | {{Facial nerve paralysis}} |
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| {{EH}}
| | ==[[Facial nerve paralysis overview|Overview]]== |
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| '''Facial nerve paralysis''' and [[Bell's Palsy|Bell's palsy]] is due to a loss of voluntary movement of the muscles on one side of the face due to abnormal function of the facial nerve(s). A Peripheral palsy affects all ipsilateral muscles of facial expression (paralysis results on the entire ipsilateral side). A supranuclear palsy involves the lower part of the face.
| | ==[[Facial nerve paralysis historical perspective|Historical Perspective]]== |
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| '''Facial nerve paralysis''' is a common problem that involves the [[paralysis]] of any structures innervated by the [[facial nerve]]. The pathway of the facial nerve is long and relatively convoluted, and so there are a number of causes that may result in facial nerve paralysis. The most common is [[Bell's palsy]], an [[idiopathic]] disease that may only be diagnosed by exclusion.
| | ==[[Facial nerve paralysis classification|Classification]]== |
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| A thorough [[medical history]] and [[physical examination]] are the first steps in making a diagnosis.
| | ==[[Facial nerve paralysis pathophysiology|Pathophysiology]]== |
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| During the '''physical examination''', a distinction must first be made between paralysis and [[paresis]] (incomplete paralysis). Not surprisingly, paralysis is far more serious and requires immediate treatment. It must also be determined whether the [[forehead]] is involved in the motor defect or not. This is usually accomplished by assessing how well a patient can raise her [[eyebrow]]s. The question is an important one because it helps determine if the lesion is in the [[upper motor neuron]] component of the facial nerve, or in its [[lower motor neuron]] component.
| | ==[[Facial nerve paralysis causes|Causes]]== |
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| Laboratory investigations include an [[audiogram]], [[nerve conduction study|nerve conduction studies]] ([[Electroneuronography|ENoG]]), [[computed tomography]] (CT) or [[MRI|magnetic resonance]] (MR) imaging.
| | ==[[Facial nerve paralysis differential diagnosis|Differentiating Facial nerve paralysis from other Diseases]]== |
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| ==Causes== | | ==[[Facial nerve paralysis epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Bell's palsy===
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| [[Bell's palsy]] is the most common cause of acute facial nerve paralysis (>80%). Previously considered [[idiopathic]], it has been recently linked to [[herpes zoster]] of the facial nerve (rarely [[Lyme disease]]). | |
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| Bell's palsy is an exclusion diagnosis. Some factors that tend to rule out Bell's palsy include:
| | ==[[Facial nerve paralysis risk factors|Risk Factors]]== |
| # Recurrent paralysis
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| # Slowly progressive paralysis (The onset of Bell's palsy is very sudden)
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| # Twitching
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| # Associated symptoms (either [[cochlea]]r or neurologic)
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| 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 include [[steroids]] and antivirals.
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| ===Trauma=== | | ==[[Facial nerve paralysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| [[Physical trauma]], especially [[fracture]]s of the [[temporal bone]], may also cause acute facial nerve paralysis. Understandably, the likelihood of facial paralysis after trauma depends on the location of the trauma. Most commonly, facial paralysis follows temporal bone fractures, though the likelihood depends on the type of fracture.
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| ''Transverse fractures'' in the horizontal plane present the highest likelihood of facial paralysis (40-50%). Patients may also present with hemotympanum (blood behind the tympanic membrane), sensory [[deaf]]ness, and [[Dizziness|vertigo]] – the latter two symptoms due to damage to [[vestibulocochlear nerve]] ([[cranial nerve]] VIII) and the inner ear. ''Longitudinal fracture'' in the vertical plane present a lower likelihood of paralysis (20%). Patients may present with hematorrhea ([[blood]] coming out of the [[external auditory meatus]]), [[tympanic membrane]] tear, fracture of [[external auditory canal]], and [[conductive hearing loss]].
| | ==Diagnosis== |
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| Traumatic injuries can be assessed by [[computed tomography]] (CT) and nerve conduction studies (ENoG). In patients with mild injury, management is the same as with Bell's palsy – protect the [[eye]]s and wait. In patients with severe injury, progress is followed with nerve conduction studies. If nerve conduction studies show a large (>90%) change in nerve conduction, the nerve should be decompressed. The facial paralysis can follow immediately the trauma due to direct damage to the facial nerve, in such cases a surgical treatment may be attempted. In other cases the facial paralysis can occur a long time after the trauma due to oedema and inflammation. In those cases steroids can be a good help.
| | [[Facial nerve paralysis history and symptoms|History and Symptoms ]] | [[ Facial nerve paralysis physical examination|Physical Examination]] | [[Facial nerve paralysis laboratory findings|Laboratory Findings]] | [[Facial nerve paralysis other imaging findings|Other Imaging Findings]] | [[Facial nerve paralysis other diagnostic studies|Other Diagnostic Studies]] |
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| ===Tumours=== | | ==Treatment== |
| A [[tumour]] compressing the facial nerve anywhere along its complex pathway can result in facial paralysis. Common culprits are [[facial neuroma]]s, congenital [[cholesteatoma]]s, [[hemangioma]]s, [[acoustic neuroma]]s, [[parotid gland]] [[neoplasm]]s, or [[metastases]] of other tumours.
| | [[Facial nerve paralysis medical therapy|Medical Therapy]] | [[Facial nerve paralysis surgery |Surgery]] | [[Facial nerve paralysis primary prevention|Primary Prevention]] |[[Facial nerve paralysis secondary prevention|Secondary Prevention]] | [[Facial nerve paralysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Facial nerve paralysis future or investigational therapies|Future or Investigational Therapies]] |
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| Patients with facial nerve paralysis resulting from tumours usually present with a progressive, twitching paralysis, other neurological signs, or a recurrent Bell's palsy-type presentation.
| | ==Case Studies== |
| The latter should always be suspicious, as Bell's palsy should not recur. A chronically discharging ear must be treated as a cholesteatoma until proven otherwise; hence, there must be immediate [[surgery|surgical]] exploration.
| | [[Facial nerve paralysis case study one|Case #1]] |
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| Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumour, and it should be managed accordingly.
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| ===''Herpes zoster oticus''===
| | {{PNS diseases of the nervous system}} |
| {{main|Ramsay Hunt syndrome type II}} | |
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| [[Herpes zoster oticus]] is essentially a [[herpes zoster]] [[infection]] that affects [[cranial nerve]]s VII ([[facial nerve]]) and VIII ([[vestibulocochlear nerve]]).
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| Patients present with facial paralysis, ear pain, [[vesicle (biology)|vesicle]]s, [[sensorineural hearing loss]], and [[dizziness|vertigo]].
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| Management includes [[antiviral]]s and oral [[steroid]]s.
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| ===Acute and chronic ''otitis media''===
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| ''[[Otitis media]]'' is an infection in the middle ear, which can spread to the facial nerve and inflame it, causing compression of the nerve in its canal.
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| [[Antibiotic]]s are used to control the ''otitis media'', and other options include a wide [[myringotomy]] (an incision in the [[tympanic membrane]]) or decompression if the patient does not improve
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| Chronic ''otitis media'' usually presents in an ear with chronic discharge ([[otorrhea]]), or hearing loss, with or without ear pain ([[otalgia]]). Once suspected, there should be immediate surgical exploration to determine if a cholesteatoma has formed and must be removed.
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| ===Neurosarcoidosis===
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| Facial nerve paralysis, sometimes bilateral, is a common manifestation of [[neurosarcoidosis]] ([[sarcoidosis]] of the nervous system), itself a rare condition.
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| == Differential Diagnosis of Causes of {{PAGENAME}}==
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| * [[Acoustic neuroma]]
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| * [[Acute otitis externa]]
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| * Altitude (barotrauma)
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| * Anti [[tetanus]] serum
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| * Basal [[skull fracture]]
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| * [[Botulism]]
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| * [[Brain stem]] injury
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| * [[Cardiofacial Syndrome]]
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| * [[Cholesteatoma]]
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| * Cortical injury
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| * [[Coxsackievirus]] infection
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| * [[Diabetes Mellitus]]
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| * [[Diphtheria]]
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| * Diving ([[barotrauma]])
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| * Familial [[Bell's Palsy|Bell's palsy]]
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| * [[Facial nerve neuroma]]
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| * Forceps delivery (birth)
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| * [[Glomus jugulare tumor]]
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| * [[Gradenigo's Syndrome]]
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| * [[Guillain-Barre Syndrome]]
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| * [[Heerfordt's Syndrome]]
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| * Hemangioblastoma
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| * [[Hemangioma]]
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| * [[Herpes zoster]] oticus
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| * Herpetic vessicles
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| * [[HIV]] infection
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| * [[Hypertension]]
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| * [[Hyperthyroidism]]
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| * [[Influenza]]
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| * [[Intoxication]]
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| * [[Ischemic cerebral insult]]
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| * [[Leprosy]]
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| * [[Lyme Disease]]
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| * Malignant [[otitis externa]]
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| * Mandibular block [[anesthesia]]
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| * [[Mastoiditis]]
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| * [[Melkersson-Rosenthal Syndrome]]
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| * [[Meningiomas]]
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| * [[Meningoencephalitis]]
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| * [[Mobius' Syndrome]]
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| * Molding (birth)
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| * [[Mononucleosis]]
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| * [[Mumps]]
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| * [[Myasthenia Gravis]]
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| * [[Parotid]] [[tumor]]
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| * [[Parotitis]]
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| * Penetrating inner ear injury
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| * Pontine [[glioma]]
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| * [[Pregnancy]]
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| * Primary temporal bone [[tumors]]
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| * [[Rabies vaccine]]
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| * [[Ramsay Hunt's Syndrome]]
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| * [[Sarcoidosis]]
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| * Surgery
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| * [[Syphilis]]
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| * [[Temporal bone]] [[fracture]]
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| * [[Tetanus]]
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| * [[Tuberculosis]]
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| * [[Tumor]]
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| == Physical Examination ==
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| * Complete ears, nose, and throat (ENT) and neurologic exams with physical
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| == Laboratory Findings ==
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| * [[Complete blood count]] ([[CBC]])
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| * [[Erythrocyte sedimentation rate]] ([[ESR]])
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| * Lyme titer
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| * [[Glucose]]
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| === MRI and CT ===
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| * Head [[MRI]]
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| * [[MRI]] and [[CT scan]] for supranuclear palsy
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| == Other Diagnostic Studies ==
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| * Workup for [[cerebrovascular accident]] ([[CVA]])
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| * Demyelinating processes
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| * [[Cerebrospinal fluid]] ([[CSF]]) analysis
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| == Treatment ==
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| * Massage of weakened muscles, tape eye and use eye shield during sleep and possible electrical stimulation of paralyzed muscles ([[Bell's Palsy|Bell's palsy]])
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| * Treat underlying disease etiologies
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| * Consider neurologic referral
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| == Pharmacotherapy ==
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| * Corticosteroids and IV acyclovir for [[Bell's Palsy|Bell's palsy]]
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| == References ==
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| {{reflist|2}}
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| ==Additional Resources==
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| * [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/AcuteFacialParalysisPowerpointDrParnes.ppt Acute facial nerve paralysis] - Powerpoint slides from a lecture presented to second year medical school students at the [http://www.uwo.ca/ University of Western Ontario] by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
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| * [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/AcuteFacialNerveParalysisDrParnes.pdf Acute facial nerve paralysis] - Notes from a lecture presented to second year medical school students at the [http://www.uwo.ca/ University of Western Ontario] by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
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| <!--
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| == Acknowledgements ==
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| The content on this page was first contributed by
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| List of contributors:
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| == Suggested Reading and Key General References ==
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| == Suggested Links and Web Resources ==
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| == For Patients ==
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| {{PNS diseases of the nervous system}}
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| {{SIB}}
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| [[Category:Neurology]] | | [[Category:Neurology]] |
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| [[Category:Oral and maxillofacial surgery]] | | [[Category:Oral and maxillofacial surgery]] |
| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
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| [[de:Fazialislähmung]]
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| [[hr:Kljenuti ličnog živca]]
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| [[no:Facialisparese]]
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| {{WH}} | | {{WH}} |
| {{WikiDoc Sources}} | | {{WS}} |
