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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. |
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| | {{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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| == 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>== | | ==[[Facial nerve paralysis overview|Overview]]== |
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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 vesicles
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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 == | | ==[[Facial nerve paralysis historical perspective|Historical Perspective]]== |
| * Complete ears, nose, and throat (ENT) and neurologic exams with physical
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| == Laboratory Findings == | | ==[[Facial nerve paralysis classification|Classification]]== |
| * [[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 === | | ==[[Facial nerve paralysis pathophysiology|Pathophysiology]]== |
| * Head [[MRI]]
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| * [[MRI]] and [[CT scan]] for supranuclear palsy
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| == Other Diagnostic Studies == | | ==[[Facial nerve paralysis causes|Causes]]== |
| * Workup for [[cerebrovascular accident]] ([[CVA]])
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| * Demyelinating processes
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| * [[Cerebrospinal fluid]] ([[CSF]]) analysis
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| == Treatment == | | ==[[Facial nerve paralysis differential diagnosis|Differentiating Facial nerve paralysis from other Diseases]]== |
| * 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 == | | ==[[Facial nerve paralysis epidemiology and demographics|Epidemiology and Demographics]]== |
| * Corticosteroids and IV acyclovir for [[Bell's Palsy|Bell's palsy]]
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| == References == | | ==[[Facial nerve paralysis risk factors|Risk Factors]]== |
| {{reflist|2}}
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| ==Additional Resources== | | ==[[Facial nerve paralysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * [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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| == Acknowledgements ==
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| The content on this page was first contributed by
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| List of contributors:
| | ==Diagnosis== |
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| == Suggested Reading and Key General References ==
| | [[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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| == Suggested Links and Web Resources == | | ==Treatment== |
| | [[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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| == For Patients == | | ==Case Studies== |
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| | [[Facial nerve paralysis case study one|Case #1]] |
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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}} |