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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
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| | 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. |
| }} | | }} |
| | {{CMG}} |
| {{Facial nerve paralysis}} | | {{Facial nerve paralysis}} |
| {{CMG}}; {{GCC}}
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| ==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.
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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.
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| A thorough [[medical history]] and [[physical examination]] are the first steps in making a diagnosis.
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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.
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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.
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| ==Causes==
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| ===Common Causes===
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| ====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 overview|Overview]]== |
| # 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 historical perspective|Historical Perspective]]== |
| [[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]].
| | ==[[Facial nerve paralysis classification|Classification]]== |
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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 pathophysiology|Pathophysiology]]== |
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| ====Tumors==== | | ==[[Facial nerve paralysis causes|Causes]]== |
| A [[tumor]] 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 tumors.
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| Patients with facial nerve paralysis resulting from tumors usually present with a progressive, twitching paralysis, other neurological signs, or a recurrent Bell's palsy-type presentation.
| | ==[[Facial nerve paralysis differential diagnosis|Differentiating Facial nerve paralysis from other Diseases]]== |
| 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.
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| Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumor, and it should be managed accordingly.
| | ==[[Facial nerve paralysis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ====Herpes zoster oticus==== | | ==[[Facial nerve paralysis risk factors|Risk Factors]]== |
| {{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]]). | | ==[[Facial nerve paralysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| 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==== | | ==Diagnosis== |
| ''[[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.
| | [[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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| ====Neurosarcoidosis==== | | ==Treatment== |
| Facial nerve paralysis, sometimes bilateral, is a common manifestation of [[neurosarcoidosis]] ([[sarcoidosis]] of the nervous system), itself a rare condition. | | [[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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| | | ==Case Studies== |
| ===Causes by Organ System=== | | [[Facial nerve paralysis case study one|Case #1]] |
| {|style="width:82%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aneurysm]], [[Arteriosclerosis]], [[Carotid artery aneurysm]], [[Cayler cardiofacial syndrome]], [[Cerebral infarction]], [[Cerebral vascular accidents]], [[DiGeorge syndrome]], [[Embolization]], [[Foix–Alajouanine syndrome]], [[Foville syndrome]], [[Hemangioblastoma]], [[Hemangioma of tympanum]], [[Hypertension]], [[Ischemic mononeuropathy]], [[Polyarteritis nodosa]], [[Pontine infarction]], [[Stroke]], [[Temporal arteritis]], [[Transient ischemic attack]], [[Vertebrobasilar dolichoectasia]], [[Wallenberg's syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical/Poisoning'''
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| |bgcolor="Beige"| [[Arsenic intoxication]], [[Carbon monoxide]], [[Chemical poisoning]], [[Cresylic acid]], [[Ethylene glycol]]
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| [[Dental procedure]]
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Facial hemiatrophy]], [[Hidradenoma]], [[Melkersson-Rosenthal-Schuermann syndrome]], [[Neurofibromatosis]], [[Systemic sclerosis]], [[Thrombotic thrombocytopenic purpura]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Thalidomide]]
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| [[Acoustic neuroma]], [[Acquired cholesteatoma]], [[Acute otitis media]], [[Adenoid cystic carcinoma]], [[Adenoidectomy]], [[Anomalous sigmoid sinus]], [[Benign lesions of parotid]], [[CHARGE syndrome]], [[Chronic otitis media]], [[Congenital cholesteatoma]], [[Deafness, conductive stapedial, with ear malformation and facial palsy]], [[Diptheria]], [[Ear surgery]], [[Enterovirus 70]], [[External otitis]], [[Goldenhar's syndrome]], [[Heerfordt-Waldenström syndrome]], [[Hemangioma of tympanum]], [[Herpes zoster oticus]], [[Middle-ear infection]], [[Otitis media]], [[Parotid gland neoplasm]], [[Parotid gland surgery]], [[Parotid tumor]], [[Penetrating injury to middle ear]], [[Posttonsillectormy]], [[Ramsay Hunt syndrome type II]], [[Salivary gland cancer]], [[Suppurative otitis media]], [[Uveoparotid fever]]
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Diabetes mellitus]], [[DiGeorge syndrome]], [[Hyperthyroidism]]
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| [[Barotrauma]]
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Albers-Schonberg disease]], [[Alternating hemiplegia]], [[Beta-ketothiolase deficiency]], [[CHARGE syndrome]], [[Craniodiaphyseal dysplasia]], [[Craniometaphyseal dysplasia]], [[Deafness, conductive stapedial, with ear malformation and facial palsy]], [[DiGeorge syndrome]], [[Dystophia myotonica]], [[Facioscapulohumeral muscular dystrophy]], [[Finnish type amyloidosis]], [[Goldenhar's syndrome]], [[Hereditary congenital facial paresis 1]], [[Hereditary congenital facial paresis 2]], [[Hereditary hypertrophic neuropathy]], [[Melkersson-Rosenthal-Schuermann syndrome]], [[Moebius syndrome]], [[Myotonic dystrophy]], [[Osteopathia striata with cranial sclerosis]], [[Osteopetrosis]], [[Trisomy 13]], [[Trisomy 18]]
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Hand-Schuller-Christian disease]], [[Leukemia]], [[Lymphoma]], [[Temporal bone leukemia]], [[Thrombotic thrombocytopenic purpura]]
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Adenoidectomy]], [[Antitetanus serum]], [[Ear surgery]], [[Iontophoresis]], [[Mandibular block anesthesia]], [[Mastoid surgery]], [[Parotid gland surgery]], [[Postimmunization]], [[Posttonsillectormy]], [[Ramsay Hunt syndrome type II]], [[Vaccine treatment for rabies]]
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Acquired immune deficiency syndrome]], [[Acute hemorrhagic conjunctivitis]], [[Acute otitis media]], [[Bell's palsy]], [[Borrelia burgdorferi]], [[Botulism]], [[Cat scratch disease]], [[Chickenpox]], [[Chronic otitis media]], [[Coxsackievirus]], [[Diptheria]], [[Enterovirus 70]], [[External otitis]], [[Geniculate herpes zoster]], [[Gnathostomiasis]], [[Gummatous meningitis]], [[Herpes simplex virus]], [[Herpes zoster oticus]], [[Herpes zoster]], [[Infectious mononucleosis]], [[Influenza]], [[Lepromatous leprosy]], [[Lyme disease]], [[Malaria]], [[Mastoiditis]], [[Middle-ear infection]], [[Mucormycosis]], [[Mumps]], [[Otitis media]], [[Poliomyelitis]], [[Shingles]], [[Suppurative otitis media]], [[Syphilis]], [[Tuberculosis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal/Orthopedic'''
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| |bgcolor="Beige"| [[Albers-Schonberg disease]], [[Basal skull fracture]], [[Cayler cardiofacial syndrome]], [[Craniodiaphyseal dysplasia]], [[Craniometaphyseal dysplasia]], [[Dystophia myotonica]], [[Facioscapulohumeral muscular dystrophy]], [[Fibrous dysplasia]], [[Hand-Schuller-Christian disease]], [[Mastoid surgery]], [[Mastoiditis]], [[Myasthenia gravis]], [[Myopathy]], [[Myotonic dystrophy]], [[Osteopathia striata with cranial sclerosis]], [[Osteopetrosis]], [[Poland's syndrome]], [[Rhabdomyosarcoma]], [[Sclerotosis]], [[Skull fracture]], [[Temporal bone fracture]], [[Temporal bone leukemia]], [[Tumor of the petrous bone]]
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Acoustic neuroma]], [[Alternating hemiplegia]], [[Bell's palsy]], [[Beta-ketothiolase deficiency]], [[Bickerstaff's brainstem encephalitis]], [[Botulism]], [[Cerebral contusion]], [[Cerebral infarction]], [[Cerebral tumor]], [[Cerebral vascular accidents]], [[Degenerative cerebral disease]], [[Encephalitis]], [[Facial hemiatrophy]], [[Facial nerve tumor]], [[Facial neuroma]], [[Foix–Alajouanine syndrome]], [[Foville syndrome]], [[Geniculate herpes zoster]], [[Glioma]], [[Glomus jugulare tumor]], [[Guillain-Barre syndrome]], [[Gummatous meningitis]], [[Heerfordt-Waldenström syndrome]], [[Hereditary hypertrophic neuropathy]], [[Herpes zoster oticus]], [[Intracranial space-occupying lesion]], [[Iontophoresis]], [[Ischemic mononeuropathy]], [[Lepromatous leprosy]], [[Lissauer's paralysis]], [[Mandibular block anesthesia]], [[Melkersson-Rosenthal-Schuermann syndrome]], [[Meningioma]], [[Miehlke syndrome]], [[Millard-Gubler syndrome]], [[Miller Fisher syndrome]], [[Moebius syndrome]], [[Motor neuron disease]], [[Multiple sclerosis]], [[Myasthenia gravis]], [[Neurofibromatosis]], [[Opercular syndrome]], [[Paraganglioma]], [[Poliomyelitis]], [[Polyneuritis cranialis]], [[Polyneuritis]], [[Polyradiculoneuropathy]], [[Pontine infarction]], [[Schwannoma]], [[Seventh nerve tumor]], [[Stroke]], [[Temporal lobe epilepsy]], [[Tetanus]], [[Transient ischemic attack]], [[Uveoparotid fever]], [[Vertebrobasilar dolichoectasia]], [[Wallenberg's syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional/Metabolic'''
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| |bgcolor="Beige"| [[Vitamin A deficiency]] | |
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| [[Difficult labour]], [[Pregnancy]]
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Acoustic neuroma]], [[Adenoid cystic carcinoma]], [[Carcinoma]], [[Cerebral tumor]], [[Cylindroma]], [[Facial nerve tumor]], [[Facial neuroma]], [[Glioma]], [[Glomus jugulare tumor]], [[Hand-Schuller-Christian disease]], [[Hemangioblastoma]], [[Leukemia]], [[Lymphoma]], [[Meningioma]], [[Metastatic neoplasm]], [[Neoplasm]], [[Neurofibromatosis]], [[Paraganglioma]], [[Parotid gland neoplasm]], [[Parotid tumor]], [[Rhabdomyosarcoma]], [[Salivary gland cancer]], [[Schwannoma]], [[Seventh nerve tumor]], [[Temporal bone leukemia]], [[Teratogenesis]], [[Teratoma]], [[Tumor of the petrous bone]]
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| |-bgcolor="LightSteelBlue"
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| | '''Ophthalmologic'''
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| |bgcolor="Beige"| [[Acute hemorrhagic conjunctivitis]], [[Heerfordt-Waldenström syndrome]], [[Uveoparotid fever]]|-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose/Toxicity'''
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| |bgcolor="Beige"| [[Alcoholism]]
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Renal/Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Rheumatology/Immunology/Allergy'''
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| |bgcolor="Beige"| [[Acquired immune deficiency syndrome]], [[Antitetanus serum]], [[Bickerstaff's brainstem encephalitis]], [[Facial hemiatrophy]], [[Guillain-Barre syndrome]], [[Miller Fisher syndrome]], [[Multiple sclerosis]], [[Myasthenia gravis]], [[Polyarteritis nodosa]], [[Postimmunization]], [[Sarcoidosis]], [[Systemic sclerosis]], [[Temporal arteritis]], [[Thrombotic thrombocytopenic purpura]], [[Vaccine treatment for rabies]]
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Barotrauma]], [[Basal skull fracture]], [[Cerebral contusion]], [[Difficult labour]], [[Facial injury]], [[Head injury]], [[Penetrating injury to middle ear]], [[Skull fracture]], [[Temporal bone fracture]], [[Trauma]]
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Amyloidosis]], [[Finnish type amyloidosis]], [[Lightning]], [[Poland's syndrome]], [[Sarcoidosis]], [[Sarcoma]]
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| |}
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| ===Causes in Alphabetical Order===
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| *[[Acoustic neuroma]]
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| *[[Acquired cholesteatoma]]
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| *[[Acquired immune deficiency syndrome]]
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| *[[Acute hemorrhagic conjunctivitis]]
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| *[[Acute otitis media]]
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| *[[Adenoid cystic carcinoma]]
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| *[[Adenoidectomy]]
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| *[[Albers-Schonberg disease]]
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| *[[Alcoholism]]
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| *[[Alternating hemiplegia]]
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| *[[Amyloidosis]]
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| *[[Aneurysm]]
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| *[[Anomalous sigmoid sinus]]
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| *[[Antitetanus serum]]
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| *[[Arsenic intoxication]]
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| *[[Arteriosclerosis]]
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| *[[Barotrauma]]
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| *[[Basal skull fracture]]
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| *[[Bell's palsy]]
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| *[[Benign lesions of parotid]]
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| *[[Beta-ketothiolase deficiency]]
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| *[[Bickerstaff's brainstem encephalitis]]
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| *[[Borrelia burgdorferi]]
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| *[[Botulism]]
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| *[[Carbon monoxide]]
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| *[[Carcinoma]]
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| *[[Carotid artery aneurysm]]
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| *[[Cat scratch disease]]
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| *[[Cayler cardiofacial syndrome]]
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| *[[Cerebral contusion]]
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| *[[Cerebral infarction]]
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| *[[Cerebral tumor]]
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| *[[Cerebral vascular accidents]]
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| *[[CHARGE syndrome]]
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| *[[Chemical poisoning]]
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| *[[Chickenpox]]
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| *[[Chronic otitis media]]
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| *[[Congenital cholesteatoma]]
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| *[[Coxsackievirus]]
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| *[[Craniodiaphyseal dysplasia]]
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| *[[Craniometaphyseal dysplasia]]
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| *[[Cresylic acid]]
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| *[[Cylindroma]]
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| *[[Deafness, conductive stapedial, with ear malformation and facial palsy]]
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| *[[Degenerative cerebral disease]]
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| *[[Dental procedure]]
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| *[[Diabetes mellitus]]
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| *[[Difficult labour]]
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| *[[DiGeorge syndrome]]
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| *[[Diptheria]]
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| *[[Dystophia myotonica]]
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| *[[Ear surgery]]
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| *[[Embolization]]
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| *[[Encephalitis]]
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| *[[Enterovirus 70]]
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| *[[Ethylene glycol]]
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| *[[External otitis]]
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| *[[Facial hemiatrophy]]
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| *[[Facial injury]]
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| *[[Facial nerve tumor]]
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| *[[Facial neuroma]]
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| *[[Facioscapulohumeral muscular dystrophy]]
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| *[[Fibrous dysplasia]]
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| *[[Finnish type amyloidosis]]
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| *[[Foix–Alajouanine syndrome]]
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| *[[Foville syndrome]]
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| *[[Geniculate herpes zoster]]
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| *[[Glioma]]
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| *[[Glomus jugulare tumor]]
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| *[[Gnathostomiasis]]
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| *[[Goldenhar's syndrome]]
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| *[[Guillain-Barre syndrome]]
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| *[[Gummatous meningitis]]
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| *[[Hand-Schuller-Christian disease]]
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| *[[Head injury]]
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| *[[Heerfordt-Waldenström syndrome]]
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| *[[Hemangioblastoma]]
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| *[[Hemangioma of tympanum]]
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| *[[Hereditary congenital facial paresis 1]]
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| *[[Hereditary congenital facial paresis 2]]
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| *[[Hereditary hypertrophic neuropathy]]
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| *[[Herpes simplex virus]]
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| *[[Herpes zoster oticus]]
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| *[[Herpes zoster]]
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| *[[Hidradenoma]]
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| *[[Hypertension]]
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| *[[Hyperthyroidism]]
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| *[[Infectious mononucleosis]]
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| *[[Influenza]]
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| *[[Intracranial space-occupying lesion]]
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| *[[Iontophoresis]]
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| *[[Ischemic mononeuropathy]]
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| *[[Lepromatous leprosy]]
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| *[[Leukemia]]
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| *[[Lightning]]
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| *[[Lissauer's paralysis]]
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| *[[Lyme disease]]
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| *[[Lymphoma]]
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| *[[Malaria]]
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| *[[Mandibular block anesthesia]]
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| *[[Mastoid surgery]]
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| *[[Mastoiditis]]
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| *[[Melkersson-Rosenthal-Schuermann syndrome]]
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| *[[Meningioma]]
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| *[[Metastatic neoplasm]]
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| *[[Middle-ear infection]]
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| *[[Miehlke syndrome]]
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| *[[Millard-Gubler syndrome]]
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| *[[Miller Fisher syndrome]]
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| *[[Moebius syndrome]]
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| *[[Motor neuron disease]]
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| *[[Mucormycosis]]
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| *[[Multiple sclerosis]]
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| *[[Mumps]]
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| *[[Myasthenia gravis]]
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| {{col-break|width=33%}}
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| *[[Myopathy]]
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| *[[Myotonic dystrophy]]
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| *[[Neoplasm]]
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| *[[Neurofibromatosis]]
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| *[[Opercular syndrome]]
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| *[[Osteopathia striata with cranial sclerosis]]
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| *[[Osteopetrosis]]
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| *[[Otitis media]]
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| *[[Paraganglioma]]
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| *[[Parotid gland neoplasm]]
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| *[[Parotid gland surgery]]
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| *[[Parotid tumor]]
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| *[[Penetrating injury to middle ear]]
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| *[[Poland's syndrome]]
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| *[[Poliomyelitis]]
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| *[[Polyarteritis nodosa]]
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| *[[Polyneuritis cranialis]]
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| *[[Polyneuritis]]
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| *[[Polyradiculoneuropathy]]
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| *[[Pontine infarction]]
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| *[[Postimmunization]]
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| *[[Posttonsillectormy]]
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| *[[Pregnancy]]
| |
| *[[Ramsay Hunt syndrome type II]]
| |
| *[[Rhabdomyosarcoma]]
| |
| *[[Salivary gland cancer]]
| |
| *[[Sarcoidosis]]
| |
| *[[Sarcoma]]
| |
| *[[Schwannoma]]
| |
| *[[Sclerotosis]]
| |
| *[[Seventh nerve tumor]]
| |
| *[[Shingles]]
| |
| *[[Skull fracture]]
| |
| *[[Stroke]]
| |
| *[[Suppurative otitis media]]
| |
| *[[Syphilis]]
| |
| *[[Systemic sclerosis]]
| |
| *[[Temporal arteritis]]
| |
| *[[Temporal bone fracture]]
| |
| *[[Temporal bone leukemia]]
| |
| *[[Temporal lobe epilepsy]]
| |
| *[[Teratogenesis]]
| |
| *[[Teratoma]]
| |
| *[[Tetanus]]
| |
| *[[Thalidomide]]
| |
| *[[Thrombotic thrombocytopenic purpura]]
| |
| *[[Transient ischemic attack]]
| |
| *[[Trauma]]
| |
| *[[Trisomy 13]]
| |
| *[[Trisomy 18]]
| |
| *[[Tuberculosis]]
| |
| *[[Tumor of the petrous bone]]
| |
| *[[Uveoparotid fever]]
| |
| *[[Vaccine treatment for rabies]]
| |
| *[[Vertebrobasilar dolichoectasia]]
| |
| *[[Vitamin A deficiency]]
| |
| *[[Wallenberg's syndrome]]
| |
| {{col-end}}
| |
| | |
| == Differential Diagnosis of {{PAGENAME}}<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>==
| |
| {{col-begin|width=85%}}
| |
| {{col-break|width=33%}}
| |
| * [[Acoustic neuroma]]
| |
| * [[Acute otitis externa]]
| |
| * Altitude (barotrauma)
| |
| * Anti [[tetanus]] serum
| |
| * Basal [[skull fracture]]
| |
| * [[Botulism]]
| |
| * [[Brain stem]] injury
| |
| * [[Cardiofacial Syndrome]]
| |
| * [[Cholesteatoma]]
| |
| * Cortical injury
| |
| * [[Coxsackievirus]] infection
| |
| * [[Diabetes Mellitus]]
| |
| * [[Diphtheria]]
| |
| * Diving ([[barotrauma]])
| |
| * Familial [[Bell's Palsy|Bell's palsy]]
| |
| * [[Facial nerve neuroma]]
| |
| * Forceps delivery (birth)
| |
| * [[Glomus jugulare tumor]]
| |
| * [[Gradenigo's Syndrome]]
| |
| * [[Guillain-Barre Syndrome]]
| |
| {{col-break|width=33%}}
| |
| * [[Heerfordt's Syndrome]]
| |
| * Hemangioblastoma
| |
| * [[Hemangioma]]
| |
| * [[Herpes zoster]] oticus
| |
| * Herpetic vesicles
| |
| * [[HIV]] infection
| |
| * [[Hypertension]]
| |
| * [[Hyperthyroidism]]
| |
| * [[Influenza]]
| |
| * [[Intoxication]]
| |
| * [[Ischemic cerebral insult]]
| |
| * [[Leprosy]]
| |
| * [[Lyme Disease]]
| |
| * Malignant [[otitis externa]]
| |
| * Mandibular block [[anesthesia]]
| |
| * [[Mastoiditis]]
| |
| * [[Melkersson-Rosenthal Syndrome]]
| |
| * [[Meningiomas]]
| |
| * [[Meningoencephalitis]]
| |
| * [[Mobius' Syndrome]]
| |
| {{col-break|width=33%}}
| |
| * Molding (birth)
| |
| * [[Mononucleosis]]
| |
| * [[Mumps]]
| |
| * [[Myasthenia Gravis]]
| |
| * [[Parotid]] [[tumor]]
| |
| * [[Parotitis]]
| |
| * Penetrating inner ear injury
| |
| * Pontine [[glioma]]
| |
| * [[Pregnancy]]
| |
| * Primary temporal bone [[tumors]]
| |
| * [[Rabies vaccine]]
| |
| * [[Ramsay Hunt's Syndrome]]
| |
| * [[Sarcoidosis]]
| |
| * Surgery
| |
| * [[Syphilis]]
| |
| * [[Temporal bone]] [[fracture]]
| |
| * [[Tetanus]]
| |
| * [[Tuberculosis]]
| |
| * [[Tumor]]
| |
| {{col-end}}
| |
| | |
| == Physical Examination ==
| |
| * Complete ears, nose, and throat (ENT) and neurologic exams with physical
| |
| | |
| == Laboratory Findings ==
| |
| * [[Complete blood count]] ([[CBC]])
| |
| * [[Erythrocyte sedimentation rate]] ([[ESR]])
| |
| * Lyme titer
| |
| * [[Glucose]]
| |
| | |
| === MRI and CT ===
| |
| * Head [[MRI]]
| |
| * [[MRI]] and [[CT scan]] for supranuclear palsy
| |
| | |
| == Other Diagnostic Studies ==
| |
| * Workup for [[cerebrovascular accident]] ([[CVA]])
| |
| * Demyelinating processes
| |
| * [[Cerebrospinal fluid]] ([[CSF]]) analysis
| |
| | |
| == Treatment ==
| |
| * 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]])
| |
| * Treat underlying disease etiologies
| |
| * Consider neurologic referral
| |
| | |
| == Pharmacotherapy ==
| |
| * Corticosteroids and IV acyclovir for [[Bell's Palsy|Bell's palsy]]
| |
| | |
| == References ==
| |
| {{reflist|2}}
| |
| | |
| ==Additional Resources==
| |
| * [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.
| |
| * [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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| -->
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| [[Category:Oral and maxillofacial surgery]] | | [[Category:Oral and maxillofacial surgery]] |
| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
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| {{WikiDoc Sources}} | | {{WS}} |
