Facial nerve paralysis: Difference between revisions
Gerald Chi (talk | contribs) m (→Tumors) |
Gerald Chi (talk | contribs) (→Causes) |
||
Line 75: | Line 75: | ||
====Neurosarcoidosis==== | ====Neurosarcoidosis==== | ||
Facial nerve paralysis, sometimes bilateral, is a common manifestation of [[neurosarcoidosis]] ([[sarcoidosis]] of the nervous system), itself a rare condition. | Facial nerve paralysis, sometimes bilateral, is a common manifestation of [[neurosarcoidosis]] ([[sarcoidosis]] of the nervous system), itself a rare condition. | ||
===Causes by Organ System=== | |||
{|style="width:82%; height:100px" border="1" | |||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Chemical/Poisoning''' | |||
|bgcolor="Beige"| [[Arsenic intoxication]], [[Carbon monoxide]], [[Chemical poisoning]], [[Cresylic acid]], [[Ethylene glycol]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Dental''' | |||
|bgcolor="Beige"| [[Dental procedure]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Dermatologic''' | |||
|bgcolor="Beige"| [[Facial hemiatrophy]], [[Hidradenoma]], [[Melkersson-Rosenthal-Schuermann syndrome]], [[Neurofibromatosis]], [[Systemic sclerosis]], [[Thrombotic thrombocytopenic purpura]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Drug Side Effect''' | |||
|bgcolor="Beige"| [[Thalidomide]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Ear Nose Throat''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Endocrine''' | |||
|bgcolor="Beige"| [[Diabetes mellitus]], [[DiGeorge syndrome]], [[Hyperthyroidism]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Environmental''' | |||
|bgcolor="Beige"| [[Barotrauma]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Gastroenterologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Genetic''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | |||
|bgcolor="Beige"| [[Hand-Schuller-Christian disease]], [[Leukemia]], [[Lymphoma]], [[Temporal bone leukemia]], [[Thrombotic thrombocytopenic purpura]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Iatrogenic''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Infectious Disease''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Musculoskeletal/Orthopedic''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Neurologic''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Nutritional/Metabolic''' | |||
|bgcolor="Beige"| [[Vitamin A deficiency]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Obstetric/Gynecologic''' | |||
|bgcolor="Beige"| [[Difficult labour]], [[Pregnancy]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Oncologic''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Ophthalmologic''' | |||
|bgcolor="Beige"| [[Acute hemorrhagic conjunctivitis]], [[Heerfordt-Waldenström syndrome]], [[Uveoparotid fever]]|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Overdose/Toxicity''' | |||
|bgcolor="Beige"| [[Alcoholism]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Psychiatric''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Pulmonary''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Renal/Electrolyte''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Rheumatology/Immunology/Allergy''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Sexual''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Trauma''' | |||
|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]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Urologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Miscellaneous''' | |||
|bgcolor="Beige"| [[Amyloidosis]], [[Finnish type amyloidosis]], [[Lightning]], [[Poland's syndrome]], [[Sarcoidosis]], [[Sarcoma]] | |||
|- | |||
|} | |||
===Causes in Alphabetical Order=== | |||
{{col-begin|width=85%}} | |||
{{col-break|width=33%}} | |||
*[[Acoustic neuroma]] | |||
*[[Acquired cholesteatoma]] | |||
*[[Acquired immune deficiency syndrome]] | |||
*[[Acute hemorrhagic conjunctivitis]] | |||
*[[Acute otitis media]] | |||
*[[Adenoid cystic carcinoma]] | |||
*[[Adenoidectomy]] | |||
*[[Albers-Schonberg disease]] | |||
*[[Alcoholism]] | |||
*[[Alternating hemiplegia]] | |||
*[[Amyloidosis]] | |||
*[[Aneurysm]] | |||
*[[Anomalous sigmoid sinus]] | |||
*[[Antitetanus serum]] | |||
*[[Arsenic intoxication]] | |||
*[[Arteriosclerosis]] | |||
*[[Barotrauma]] | |||
*[[Basal skull fracture]] | |||
*[[Bell's palsy]] | |||
*[[Benign lesions of parotid]] | |||
*[[Beta-ketothiolase deficiency]] | |||
*[[Bickerstaff's brainstem encephalitis]] | |||
*[[Borrelia burgdorferi]] | |||
*[[Botulism]] | |||
*[[Carbon monoxide]] | |||
*[[Carcinoma]] | |||
*[[Carotid artery aneurysm]] | |||
*[[Cat scratch disease]] | |||
*[[Cayler cardiofacial syndrome]] | |||
*[[Cerebral contusion]] | |||
*[[Cerebral infarction]] | |||
*[[Cerebral tumor]] | |||
*[[Cerebral vascular accidents]] | |||
*[[CHARGE syndrome]] | |||
*[[Chemical poisoning]] | |||
*[[Chickenpox]] | |||
*[[Chronic otitis media]] | |||
*[[Congenital cholesteatoma]] | |||
*[[Coxsackievirus]] | |||
*[[Craniodiaphyseal dysplasia]] | |||
*[[Craniometaphyseal dysplasia]] | |||
*[[Cresylic acid]] | |||
*[[Cylindroma]] | |||
*[[Deafness, conductive stapedial, with ear malformation and facial palsy]] | |||
*[[Degenerative cerebral disease]] | |||
*[[Dental procedure]] | |||
*[[Diabetes mellitus]] | |||
*[[Difficult labour]] | |||
*[[DiGeorge syndrome]] | |||
*[[Diptheria]] | |||
*[[Dystophia myotonica]] | |||
*[[Ear surgery]] | |||
*[[Embolization]] | |||
*[[Encephalitis]] | |||
*[[Enterovirus 70]] | |||
*[[Ethylene glycol]] | |||
*[[External otitis]] | |||
*[[Facial hemiatrophy]] | |||
{{col-break|width=33%}} | |||
*[[Facial injury]] | |||
*[[Facial nerve tumor]] | |||
*[[Facial neuroma]] | |||
*[[Facioscapulohumeral muscular dystrophy]] | |||
*[[Fibrous dysplasia]] | |||
*[[Finnish type amyloidosis]] | |||
*[[Foix–Alajouanine syndrome]] | |||
*[[Foville syndrome]] | |||
*[[Geniculate herpes zoster]] | |||
*[[Glioma]] | |||
*[[Glomus jugulare tumor]] | |||
*[[Gnathostomiasis]] | |||
*[[Goldenhar's syndrome]] | |||
*[[Guillain-Barre syndrome]] | |||
*[[Gummatous meningitis]] | |||
*[[Hand-Schuller-Christian disease]] | |||
*[[Head injury]] | |||
*[[Heerfordt-Waldenström syndrome]] | |||
*[[Hemangioblastoma]] | |||
*[[Hemangioma of tympanum]] | |||
*[[Hereditary congenital facial paresis 1]] | |||
*[[Hereditary congenital facial paresis 2]] | |||
*[[Hereditary hypertrophic neuropathy]] | |||
*[[Herpes simplex virus]] | |||
*[[Herpes zoster oticus]] | |||
*[[Herpes zoster]] | |||
*[[Hidradenoma]] | |||
*[[Hypertension]] | |||
*[[Hyperthyroidism]] | |||
*[[Infectious mononucleosis]] | |||
*[[Influenza]] | |||
*[[Intracranial space-occupying lesion]] | |||
*[[Iontophoresis]] | |||
*[[Ischemic mononeuropathy]] | |||
*[[Lepromatous leprosy]] | |||
*[[Leukemia]] | |||
*[[Lightning]] | |||
*[[Lissauer's paralysis]] | |||
*[[Lyme disease]] | |||
*[[Lymphoma]] | |||
*[[Malaria]] | |||
*[[Mandibular block anesthesia]] | |||
*[[Mastoid surgery]] | |||
*[[Mastoiditis]] | |||
*[[Melkersson-Rosenthal-Schuermann syndrome]] | |||
*[[Meningioma]] | |||
*[[Metastatic neoplasm]] | |||
*[[Middle-ear infection]] | |||
*[[Miehlke syndrome]] | |||
*[[Millard-Gubler syndrome]] | |||
*[[Miller Fisher syndrome]] | |||
*[[Moebius syndrome]] | |||
*[[Motor neuron disease]] | |||
*[[Mucormycosis]] | |||
*[[Multiple sclerosis]] | |||
*[[Mumps]] | |||
*[[Myasthenia gravis]] | |||
{{col-break|width=33%}} | |||
*[[Myopathy]] | |||
*[[Myotonic dystrophy]] | |||
*[[Neoplasm]] | |||
*[[Neurofibromatosis]] | |||
*[[Opercular syndrome]] | |||
*[[Osteopathia striata with cranial sclerosis]] | |||
*[[Osteopetrosis]] | |||
*[[Otitis media]] | |||
*[[Paraganglioma]] | |||
*[[Parotid gland neoplasm]] | |||
*[[Parotid gland surgery]] | |||
*[[Parotid tumor]] | |||
*[[Penetrating injury to middle ear]] | |||
*[[Poland's syndrome]] | |||
*[[Poliomyelitis]] | |||
*[[Polyarteritis nodosa]] | |||
*[[Polyneuritis cranialis]] | |||
*[[Polyneuritis]] | |||
*[[Polyradiculoneuropathy]] | |||
*[[Pontine infarction]] | |||
*[[Postimmunization]] | |||
*[[Posttonsillectormy]] | |||
*[[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>== | == 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>== |
Revision as of 20:07, 8 July 2013
For patient information click here
Facial nerve paralysis | |
Moche. Culture Representation of Facial Paralysis. 300 A.D. Larco Museum Collection, Lima, Peru. | |
ICD-9 | 351 |
eMedicine | plastic/522 |
MeSH | D005158 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Facial nerve paralysis and 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 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.
A thorough medical history and physical examination are the first steps in making a diagnosis.
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 eyebrows. 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.
Laboratory investigations include an audiogram, nerve conduction studies (ENoG), computed tomography (CT) or magnetic resonance (MR) imaging.
Causes
Common Causes
Bell's palsy
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).
Bell's palsy is an exclusion diagnosis. Some factors that tend to rule out Bell's palsy include:
- Recurrent paralysis
- Slowly progressive paralysis (The onset of Bell's palsy is very sudden)
- Twitching
- 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 include steroids and antivirals.
Trauma
Physical trauma, especially fractures 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.
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 deafness, and 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.
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 eyes 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.
Tumors
A tumor compressing the facial nerve anywhere along its complex pathway can result in facial paralysis. Common culprits are facial neuromas, congenital cholesteatomas, hemangiomas, acoustic neuromas, parotid gland neoplasms, or metastases of other tumors.
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. 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 surgical exploration.
Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumor, and it should be managed accordingly.
Herpes zoster oticus
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 antivirals and oral steroids.
Acute and chronic otitis media
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. Antibiotics 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
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.
Neurosarcoidosis
Facial nerve paralysis, sometimes bilateral, is a common manifestation of neurosarcoidosis (sarcoidosis of the nervous system), itself a rare condition.
Causes by Organ System
Causes in Alphabetical Order
Differential Diagnosis of Facial nerve paralysis[1][2]
- 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
- Facial nerve neuroma
- Forceps delivery (birth)
- Glomus jugulare tumor
- Gradenigo's Syndrome
- Guillain-Barre Syndrome
- 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
- 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
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
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)
- Treat underlying disease etiologies
- Consider neurologic referral
Pharmacotherapy
- Corticosteroids and IV acyclovir for Bell's palsy
References
Additional Resources
- Acute facial nerve paralysis - Powerpoint slides from a lecture presented to second year medical school students at the University of Western Ontario by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
- Acute facial nerve paralysis - Notes from a lecture presented to second year medical school students at the University of Western Ontario by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
Template:PNS diseases of the nervous system
de:Fazialislähmung hr:Kljenuti ličnog živca no:Facialisparese