Management of Facial Palsy

2011 ◽  
Author(s):  
Ralph E. Wesley
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Trigeminal Nerve ◽  
Facial Palsy ◽  
Cranial Nerve ◽  
Gland Secretion ◽  
Effective Management ◽  
Blurred Vision ◽  
Pterygopalatine Ganglion ◽  
Sensory Fibers

Facial palsy can devastate patients. Facial appearance can be grossly distorted by the sagging of half the face, often accompanied by drooling of food and saliva from the paralyzed lip. Blurred vision and ocular pain from exposure and dryness may interfere with the patient’s ability to perform an occupation or interact socially. Many patients with facial palsy experience depression or severe discouragement. Effective management of ocular problems by the ophthalmologist can have a profound effect on the patient’s rehabilitation. The ophthalmologist managing facial palsy should be aware of wide-ranging choices in the medical and surgical armamentarium to treat facial palsy. This chapter describes the varying clinical dimensions of facial palsy so that treatment can be individualized for effective management. The facial nerve (cranial nerve VII) has four important functions: 1. The facial motor nucleus controls muscles of facial expression, including the orbicularis oculi. 2. The superior salivatory nucleus sends parasympathetic fibers for lacrimal gland secretion and salivary secretion. 3. The nucleus solitarius receives sensory fibers of taste for the anterior two thirds of the tongue. 4. The trigeminal sensory nucleus receives sensory fibers for a small portion of the external ear. Facial motor fibers constitute about 58% of the 7,000 fibers of the facial nerve, while preganglionic fibers for tearing and salivation represent about 24%. The facial nerve leaves the cerebellopontine angle caudal to the trigeminal nerve adjacent to the nervus intermedius and then enters the internal auditory canal of the temporal bone. Large lesions of cranial nerve VII or VIII may cause loss of corneal sensation from pressure on the trigeminal nerve. The 30-mm course through the temporal bone is the longest interosseous course of any cranial nerve, which makes the facial nerve vulnerable to swelling. Three branches leave the facial nerve within the temporal bone. The first, and most important, arises at the geniculate ganglion just as the nerve makes a sharp bend, or genu, to head posteriorly. These fibers for lacrimal and palatine gland secretion constitute the greater superficial petrosal nerve carrying lacrimal secretory fibers to the pterygopalatine ganglion.

Unusual otological manifestations in Camurati-Engelmann's Disease

2006 ◽  
Vol 120 (10) ◽  
pp. 892-895 ◽  
Author(s):  
I Moumoulidis ◽  
R De ◽  
R Ramsden ◽  
D Moffat
Keyword(s):  
Temporal Bone ◽  
Middle Ear ◽  
Trigeminal Nerve ◽  
Facial Palsy ◽  
Cranial Nerve ◽  
Rare Case ◽  
Visual Loss ◽  
Long Bones ◽  
Sensory Deficits ◽  
Multiple Cranial Nerve

Camurati-Engelmann's disease (CED) is a rare hereditary disorder affecting mainly the diaphysis of long bones but multiple cranial nerve deficits may also develop secondary to bony sclerosis of their foramina, including visual loss, facial palsy, deafness, vestibular disturbances and sensory deficits along the distribution of the trigeminal nerve. Deafness has been reported in about 18 per cent of these cases due to narrowing of the internal auditory canals caused by bony encroachment on nerves and vessels. We report an extremely rare case of a patient with CED who presented with deafness due to gross abnormalities affecting both middle ear and cochlea. The issues relating to the management of these patients with temporal bone involvement are discussed.

scholarly journals Congenital unilateral facial palsy revealing a facial nerve agenesis: a case report and review of the literature

2019 ◽  
Vol 5 (1) ◽  
pp. 20180029
Author(s):  
Yaotse Elikplim Nordjoe ◽  
Ouidad Azdad ◽  
Mohamed Lahkim ◽  
Laila Jroundi ◽  
Fatima Zahrae Laamrani
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Rare Condition ◽  
Review Of The Literature ◽  
Moebius Syndrome ◽  
Temporal Bone Ct

Facial nerve aplasia is an extremely rare condition that is usually syndromic, namely, in Moebius syndrome. The occurrence of isolated agenesis of facial nerve is even rarer, with only few cases reported in the literature. We report a case of congenital facial paralysis due to facial nerve aplasia diagnosed on MRI, while no noticeable abnormality was detected on the temporal bone CT.

Course of the Peripheral Gustatory Nerves

1977 ◽  
Vol 86 (2) ◽  
pp. 251-258 ◽  
Author(s):  
Heinz Rollin
Keyword(s):  
Facial Nerve ◽  
Medulla Oblongata ◽  
Trigeminal Nerve ◽  
Soft Palate ◽  
Cranial Nerve ◽  
Anterior Part ◽  
Posterior Part ◽  
Greater Superficial Petrosal Nerve ◽  
The Brain

The multiple variations of the course of the gustatory nerves still considered possible are discussed. Recent investigations lead to the conclusion that there is only one path for the gustatory fibers for each gustatory area: 1) from the anterior part of the tongue via the tympanic cord and facial nerve to the medulla oblongata; 2) for the posterior part of the tongue in the IX cranial nerve; and 3) from the soft palate via the greater superficial petrosal nerve to the facial nerve. The trigeminal nerve carries no gustatory fibers to the brain.

Dual Coaptation of Facial Nerve Using Masseteric Branch of Trigeminal Nerve for Iatrogenic Facial Palsy: Preliminary Reports

2019 ◽  
Vol 129 (5) ◽  
pp. 505-511
Author(s):  
Yoon Se Lee ◽  
Joong Ho Ahn ◽  
Hong Ju Park ◽  
Ho Jun Lee ◽  
Mi Rye Bae ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Trigeminal Nerve ◽  
Facial Palsy ◽  
Recovery Period ◽  
Interposition Graft ◽  
Dynamic Movement ◽  
Facial Reanimation ◽  
Group A ◽  
Group B ◽  
Eye Closure

Objectives: Immediate facial nerve substitution or graft technique has been used for the repair of facial nerve defects occurring as a result of tumour dissection. However, some patients report unsatisfactory outcomes, such as difficulty in maintaining resting or smiling symmetry, due to persistent flaccid facial palsy. Here we evaluated the functional outcomes of transferring the masseteric branch of the trigeminal nerve to the facial nerve adjunct to facial nerve graft. Methods: We reviewed the medical records of seven patients who underwent facial reanimation surgery between 2014 and 2016. The patients were divided into two groups according to the type of facial reanimation surgery: group A, masseteric nerve innervation with interposition graft; group B, interposition graft only. The postoperative resting symmetry and dynamic movement were compared. Results: Facial contraction was first observed in group A at 4 months and in group B at 7.3 months. Most of the patients achieved reliable resting symmetry; however, one patient in group B exhibited unsatisfactory facial weakness on the affected side. Group A patients showed better dynamic movement than group B patients. Eye closure, oral excursion and oral continence were better in group A than in group B patients. Smile symmetry in both groups was similar due to hyperkinetic movement in group A patients and flaccidity in group B patients. Conclusions: Dual innervation of the masseteric branch of the trigeminal nerve improves the dynamic movement of paralysed facial muscles and shortens the recovery period in patients with iatrogenic facial palsy.

Intracranial hypoglossal schwannoma as an unusual cause of facial nerve palsy

1982 ◽  
Vol 56 (3) ◽  
pp. 420-423 ◽  
Author(s):  
Eugen J. Dolan ◽  
William S. Tucker ◽  
Dov Rotenberg ◽  
Mario Chui
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Content Type ◽  
Hypoglossal Schwannoma ◽  
Fine Print

✓ A case is presented in which facial palsy resulted from a hypoglossal schwannoma encircling the nerve in its course through the temporal bone.

scholarly journals Post-traumatic bilateral longitudinal temporal bone fracture with bilateral facial nerve palsy: a rare case

2020 ◽  
Vol 13 (2) ◽  
pp. e233728
Author(s):  
Kappagantu Krishna Medha ◽  
Manish Gupta ◽  
Monica Gupta
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Metabolic Disorders ◽  
Facial Nerve Palsy ◽  
Bone Fractures ◽  
Temporal Bone Fracture ◽  
Early Improvement ◽  
Post Traumatic

Facial paralysis is a potentially disabling complication of temporal bone fractures. Although unilateral palsy is commonly encountered, bilateral facial nerve palsy is rare, especially in post-traumatic situations. Other recognised causes of bilateral facial palsy are neurologic, infectious, neoplastic, idiopathic or metabolic disorders. A 25-year-old male patient presented with difficulty in talking, eating and closing eyes for 15 days since a post-vehicular accident. CT of skull showed bilateral longitudinal temporal bone fractures. Bilateral facial palsy was confirmed by clinical and topodiagnostic tests. Patient was given a course of steroids which led to an early improvement on left side followed by a delayed right-sided improvement at 6 months.

Transmastoid Decompression of the Facial Nerve in Temporal Bone Fracture

1982 ◽  
Vol 90 (5) ◽  
pp. 616-621 ◽  
Author(s):  
Naoaki Yanagihara
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Bone Fracture ◽  
Facial Palsy ◽  
Bone Fractures ◽  
Closed Head Injury ◽  
Geniculate Ganglion ◽  
Middle Fossa ◽  
Temporal Bone Fracture ◽  
Middle Fossa Approach

Among 41 cases of facial palsy caused by closed head injury, temporal bone fractures were surgically confirmed in 36 cases, of which there were two mixed fractures and 34 longitudinal fractures. The fracture involved the geniculate ganglion area in 20 cases (55%). In 15 cases, decompression of the facial nerve was carried out using the transmastoid supralabyrinthine approach with disarticulation of the incus; in only five cases was the middle fossa approach used. The technique avoids the craniotomy for the middle fossa approach and is a reliable method of treatment in the majority of patients with facial palsy caused by temporal bone fracture involving the geniculate ganglion area.

Primary intratemporal tumours of the facial nerve: Diagnosis and treatment

1990 ◽  
Vol 104 (10) ◽  
pp. 765-771 ◽  
Author(s):  
Mario Sanna ◽  
Carlo Zinia ◽  
Roberto Gamoletri ◽  
Enrico Pasanisi
Keyword(s):  
Diagnostic Imaging ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Palsy ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Review Of The Literature ◽  
Diagnostic Imaging Techniques ◽  
Diagnostic Modalities ◽  
Nerve Tumour

AbstractBenign primary tumours of the facial nerve are uncommon. A slowly progressive facial palsy should be considered the result of a nerve tumour untilproven otherwise.Improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre-operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations.A series of 12 cases of primary facial nerve tumours is presented. The clinical features, diagnostic modalities and treatment are discussed in relation to a review of the literature.

scholarly journals Facial nerve paralysis as first sign of metastatic breast cancer to the temporal bone

2018 ◽  
Vol 146 (11-12) ◽  
pp. 685-688
Author(s):  
Miljan Folic ◽  
Dragoslava Djeric
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Breast Carcinoma ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Palsy ◽  
Metastatic Breast ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Peripheral Facial Palsy

Introduction. Facial nerve paralysis originates from various factors, although in most cases etiology is idiopathic. Temporal bone metastases are quite rare, but should still be suspected in cases when congenital disorders, inflammatory disease, infection or trauma are excluded as cause of facial palsy. We present an unusual case of facial nerve paralysis as the initial sign of temporal bone metastasis of breast carcinoma and discuss diagnostic pitfalls. Case outline. A 70-year-old patient presented with facial nerve palsy, severe otalgia, hearing loss and vertigo. Patient underwent steroid treatment 6 months earlier due to peripheral facial palsy with complete neurological resolution. CT scan revealed osteolytic lesion of the right temporal bone with extension into the parietal bone and soft-tissue. Additional examination confirmed ductal breast carcinoma and osteolysis of the ribs and vertebrae. After four months, the patient with metastatic breast carcinoma to the temporal bone died despite chemotherapy. Conclusion. Temporal bone metastasis of breast cancer is very rare condition with poor prognosis. Late diagnosis and inadequate management of breast cancer are factors that contribute to the temporal bone metastasis formation. Temporal bone metastasis should be excluded in elderly patients, both with and without any history of malignancy, especially in cases of peripheral facial palsy refractory to treatment.

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