ENT (Otorhinolaryngology) · MU Sofia

15. Peripheral paralysis of the facial nerve.

Covers peripheral facial nerve palsy, starting with its definition as a lower motor neuron lesion affecting the whole hemiface. It then works through the causes grouped as idiopathic, infectious, traumatic, neoplastic, neurological and congenital, followed by the House-Brackmann grading scale and the central versus peripheral distinction. The note also outlines clinical signs, electrodiagnostic and imaging tests, medical, surgical and rehabilitation treatment, complications, and a comparison table of differential diagnoses.

Inside: 8 sections · 3 labelled pictures · 1 table · 13 flashcards · 6 min

Topic 15 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 8 sections, about 778 words (6 min of reading), with 13 flashcards.

In this note

  1. Peripheral Paralysis of the Facial Nerve
  2. Etiopathogenesis
  3. Classification
  4. Clinical Picture
  5. Paraclinical and Radiological Examinations
  6. Treatment Options
  7. Possible Complications
  8. Differential Diagnosis

Peripheral Paralysis of the Facial Nerve

1. Definition: Peripheral Facial Nerve Paralysis is the weakness or paralysis of the entire hemiface caused by a lesion affecting the Facial Nerve (CN VII) anywhere along its course after the facial nucleus in the brainstem, including the nucleus itself, its segment in the temporal bone, or its branches in the face. lower motor neuron (LMN) lesion of the facial nerve (CN VII) causing paralysis of all muscles of facial expression on the affected side, including the forehead.

Etiopathogenesis

  1. 1. Bell's Palsy (Idiopathic): Accounts for over 70% of cases.
  2. Etiopathogenesis: Strongly believed to be caused by reactivation of the Herpes Simplex Virus Type 1 (HSV-1). Viral inflammation and edema lead to entrapment and compression of the facial nerve within its narrow bony canal (the facial canal) inside the temporal bone, resulting in ischemia and demyelination of the nerve.
  3. 2. Infectious:
  4. Herpes Zoster Oticus (Ramsay Hunt Syndrome): Caused by Varicella Zoster Virus (VZV) reactivation in the geniculate ganglion. More severe and often associated with vesicular rash, vertigo, and SNHL.
  5. Otitis Media/Mastoiditis: Spread of infection/inflammation from the middle ear to the nerve.
  6. Lyme Disease: Caused by Borrelia burgdorferi.
  7. 3. Traumatic:
  8. Temporal Bone Fracture: Most common in transverse fractures.
  9. Iatrogenic: Following ear/mastoid surgery (eg, stapedectomy, mastoidectomy, parotidectomy).
  10. 4. Neoplastic:
  11. Vestibular Schwannoma (Acoustic Neuroma), Parotid Gland Tumors (malignant tumors are highly likely to cause facial palsy), Cholesteatoma.
  12. 5. Neurological/Systemic:
  13. Stroke (Central Paralysis), Multiple Sclerosis, Sarcoidosis (Heerfordt's Syndrome).
  14. 6. Congenital
  15. Birth trauma
  16. Möbius syndrome

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