Facial Nerve
Facial nerve : Facial nerve enters the ear through the internal auditory meatus .
In ear it passes through a bony canal known as Fallopian canal . It has 3 segments : 1) Labyrinthine 2) Horizontal 3) Vertical
Labyrinthine segment = narrowest segment= bottleneck of facial nerve
Facial nerve has two bends : 1st genu has geniculate ganglion
2nd genu
Facial nerve has 3 branches in the ear :
1) branch from 1st genu : greater superficial petrosal nerve supllies the lacrimal glands
2) branch from second genu : nerve to stapedius
3) from vertical segment : chorda tympani nerve , supplies taste sensation to anterior two third of tongue .
BELL'S PALSY : Idiopathic sudden onset LMN facial palsy .Recent studies suggested the role of HSV as etiology .
Forehead muscles because it is lower motor neuron disease .
Note : In upper motor neuron forehead muscles aren't paralysed .
DOC for Bell's palsy : Oral steroids for 3 weeks . recovery is seen in 85% of cases, very good recovery .
Treatment of Bell's palsy : 1) Care of the eye : Artificial tear drops to prevent exposure keratitis
2) Acylovir : If patient present within 3 days .
3) Physiotherapy
If a patient of Bell's palsy is not improving after 3 weeks , do electrophysiological nerve testing , electroneuronography . If in ENG nerve degeneration is more than 90% then Facial nerve decompression has to be done .( Remove facial nerve from canal )
If in ENG degeneration is less than 90% continue with steroid .
Recurrence of Bell's palsy is low , 4.5 to 15% .
Herpes Zoster Oticus : Also known as Ramsay Hunt Syndrome .
Etiology : Varicella Zoster Virus
VZV harbours a ganglion and reactivates .
C/F : Vesicles over pinna and external auditory canal . It is LMN facial palsy .
8th nerve involvement : SNHL , vertigo
5th nerve involvement : anaesthesia of face
DOC : Acyclovir
Recovery is seen in 50% of cases .
Poor prognosis .
Causes of bilateral facial palsy : 1) Sarcoidosis 2) DM 3) Infectious mononucleosis 4)Lime's disease
MELKERSSON ROSENTHAL SYNDROME :
1 ) Recurrent facial palsy
2) Fissuring of tongue
3) Swelling of lips .
In ear it passes through a bony canal known as Fallopian canal . It has 3 segments : 1) Labyrinthine 2) Horizontal 3) Vertical
Labyrinthine segment = narrowest segment= bottleneck of facial nerve
Facial nerve has two bends : 1st genu has geniculate ganglion
2nd genu
Facial nerve has 3 branches in the ear :
1) branch from 1st genu : greater superficial petrosal nerve supllies the lacrimal glands
2) branch from second genu : nerve to stapedius
3) from vertical segment : chorda tympani nerve , supplies taste sensation to anterior two third of tongue .
BELL'S PALSY : Idiopathic sudden onset LMN facial palsy .Recent studies suggested the role of HSV as etiology .
Forehead muscles because it is lower motor neuron disease .
Note : In upper motor neuron forehead muscles aren't paralysed .
DOC for Bell's palsy : Oral steroids for 3 weeks . recovery is seen in 85% of cases, very good recovery .
Treatment of Bell's palsy : 1) Care of the eye : Artificial tear drops to prevent exposure keratitis
2) Acylovir : If patient present within 3 days .
3) Physiotherapy
If a patient of Bell's palsy is not improving after 3 weeks , do electrophysiological nerve testing , electroneuronography . If in ENG nerve degeneration is more than 90% then Facial nerve decompression has to be done .( Remove facial nerve from canal )
If in ENG degeneration is less than 90% continue with steroid .
Recurrence of Bell's palsy is low , 4.5 to 15% .
Herpes Zoster Oticus : Also known as Ramsay Hunt Syndrome .
Etiology : Varicella Zoster Virus
VZV harbours a ganglion and reactivates .
C/F : Vesicles over pinna and external auditory canal . It is LMN facial palsy .
8th nerve involvement : SNHL , vertigo
5th nerve involvement : anaesthesia of face
DOC : Acyclovir
Recovery is seen in 50% of cases .
Poor prognosis .
Causes of bilateral facial palsy : 1) Sarcoidosis 2) DM 3) Infectious mononucleosis 4)Lime's disease
MELKERSSON ROSENTHAL SYNDROME :
1 ) Recurrent facial palsy
2) Fissuring of tongue
3) Swelling of lips .
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