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facial nerve palsy

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Bell’s palsy

Acute peripheral paralysis of the face due to a herpes simplex immune-mediated condition, often characterised by severe pain arising in the trigeminal nerve, the chief sensory nerve of the face, which arises in cranial nerve VII.
 
Clinical findings
Abrupt onset, drooping mouth, unblinking eye, twisted nose, uneven smile, distorted expressions; paralysis hits maximum in 1 to 14 days; retroauricular pain, facial numbness, epiphora, parageusia, decreased tearing, hyperacusis, hypoesthesia or dysesthesia of cranial nerves (CN V and IX), motor paresis of CN IX and X, papillitis of tongue.
 
Epidemiology
Risk of Bell’s palsy increases with age; age 10 to 19, 2:1 female:male ratio; age 40, 3:2 men:women ratio; pregnant women have 3.3 times increased risk than nonpregnant; DM = 4.5 times increased risk of BP; 10% of patients have positive family Hx of BP.
 
DiffDx, unilateral
Tumours or masses, otitis media, sarcoid, Lyme disease, skull fracture, facial injury.
 
DiffDx, bilateral
Guillain-Barré syndrome, Melkersson-Rosenthal syndrome, Möbius syndrome, motor neuron disease, myasthenia gravis.

Aetiology
Trauma, Bell’s palsy, stroke, parotid tumours, intracranial tumours.
 
Management
Microvascular and micro-neurosurgical tissue transfers allow restoration of functional, unconscious, symmetrical facial movements; acyclovir; steroids (uncertain efficacy); artificial tears; neuromuscular retraining—e.g., mirror/visual feedback, biofeedback or electromyography feedback.
 
Prognosis
60 to 80% recover, especially if incomplete paralysis, and patient is young.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

facial nerve palsy

 Facial palsy, see there.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
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References in periodicals archive
Facial nerve palsy and erosion of vital intratemporal structures can occur as a result of pressure erosion of the bony EAC and adjacent structures.
Sarella et al [8] reported one case of facial nerve palsy during third trimester of pregnancy.
In addition to malignancy, autoimmune conditions such as granulomatosis with polyangiitis and sarcoidosis and immunodeficiency conditions should also be considered in the differential diagnosis of cases of refractory chronic otitis media with facial nerve palsy. Delay in management of such cases usually occurs due to a low index of suspicion of the treating physician.
Differential diagnosis of facial nerve palsy. Otolaryngol Clin North Am.
Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Eye (Lond).
HBS has been mostly widely used in studies of peripheral facial nerve palsy in recent years.
The infant was clinically diagnosed to have facial nerve palsy on the left side.
Before concurrent radiotherapy and chemotherapy, a total parotidectomy is recommended as a treatment for metastasis of parotid glands in literature because facial nerve function may not be preserved well enough under unsatisfactory locoregional control; on the other hand, if the facial nerve has been involved in a metastatic NPC lesion of parotid glands, radiotherapy deserves consideration before surgery because more or less postoperative facial nerve palsy might be inevitable after surgical intervention.
Marked athetoid writhing of the trunk, arms and legs - worse distally and with eyes closed, disappearing while asleep; an ataxic, wide-based gait with left foot drop (power 2/5); a complete right peripheral facial nerve palsy; right-sided fixed-flexion deformity of the first, third and fourth digits and fixed extension of the wrist (Figure 1); anaesthesia of the lower limbs to the level of the mid-tibia, with preservation of sensation on the dorsum of the right foot and loss of proprioception and vibration in the upper limbs to the elbow and in the left lower limb to the knee.
Physical treatment of peripheral facial nerve palsy comprises superficial heat therapy (hot pack or infrared), electrical stimulation, massage, exercise, and biofeedback training.
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