Facial palsy

facial nerve palsy

1. Facial Palsy Ankit Kumar Radiotherapy Tutor

2. Content Introduction Definition Anatomy of facial nerves Types Etiology Sign & Symptoms Diagnosis Treatment Prognosis Complication

3. Introduction Palsy :- Complete or partial muscle paralysis, often accompanied by loss of sensation and uncontrollable body movements or tumors. Paresis :- Muscular weakness Paralysis :- Complete loss of muscle function Facial palsy :- Loss of facial movement due to nerve damage .

4. Definition It is a neurological condition in which function of facial nerve (cranial nerve VII) is partially or completely lost. It may appear to droop to become weak. Affect one or both side of face.

5. Anatomy of facial nerves

6. Peripheral facial palsy

7. Central face palsy Lesion occurs between cortex and nuclei in the brain stem. Manifest with impairment of the lower contralateral mimic musculature.

8. Peripheral facial palsy Lesion occurs between nuclei in the brainstem and peripheral organs. It leads to impairment of the ipsilateral mimic muscles and also affects the eyelids and forehead. Cause various sensory and autonomic disorders ( depending on the exact location of the lesion).

9. Etiology Idiopathic (50% of cases) – acute idiopathic peripheral facial palsy- known as Bell palsy. Secondary :- Trauma – Temporal bone fracture Infection :- HZV (Herpes zoster virus), borreliosis, HSV (Herpes simplex virus), HIV infection Tumors Pregnancy Diabetes mellitus Guillain – Barre syndrome Sarcoidosis Amyloidosis Stroke

10. Sign & Symptoms Sudden onset symptoms usually in hours, maximal weakness in 48 hrs. Unilateral Eyebrow sagging Inability to close eye Loss of nasolabial fold Decreased tearing Hyperacusis Loss of taste to anterior 2/3 tongue. Mouth droop

11. Eyebrow sagging Nasolabial fold

12. Diagnosis Physical examination :- To move facial muscles by closing eyes, lifting brow, showing teeth and frowning and other movements. EMG ( Electromyography) :- To confirm the presence of nerve damage and determine its severity. It measures the electrical activity of a muscle in response to stimulation and the nature and the speed of the conduction of electrical impulses along a nerve. Imaging – CT , MRI To rule out other possible sources pressure on the facial nerve, such as tumor or skull fracture.

13. EMG CT MRI

14. Treatment Corticosteroids – Prednisone powerful anti-inflammatory agent Reduce the swelling of the facial nerve. Anti-viral drugs It added to steroids are possibly beneficial for some people with Bell’s palsy, but this is still unproved. In severe cases Valacyclovir- for 1 week Eye care with – artificial tears

15. Traumatic facial nerve palsy surgical decompression or nerve repair In the past, Decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today isn’t recommended . Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.

16. Prognosis Idiopathic facial palsy- complete recovery in- 85%of cases( within 3 weeks) If motor nerve conduction studies show evidence of denervation after 10 days indicates prolonged recovery of – 3 months and possible incomplete recovery.

17. Complication Dural tears Conductive or sensory neural hearing loss Vestibular function loss Persistent CSF leaks Meningitis Injury to the anterior inferior cerebellar artery (AICA) or its branches.