Pathogenesis (development of disease) Facial nerve palsy represents paralysis of the muscles innervated by the facial nerve, the facial nerve. The facial nerve is the VII cranial nerve. It is involved in the following processes, among others: Innervation of the facial muscles Sensation of taste [chorda tympani]. Salivary gland secretion: submandibular gland and sublingual gland … Facial Nerve Palsy: Causes
General measures Exercise treatment (mimic exercises) according to instructions and under self-control (each muscle for two minutes each; several times daily). Corneal protection of the eye in case of insufficient eyelid closure by using artificial tear fluid (e.g., liposomal eye spray), dexpanthenol eye ointment, and nightly watch glass dressing (a clear plexiglass cap enclosed with … Facial Nerve Palsy: Therapy
Central facial nerve palsy Remain mobile forehead muscles (frowning is possible) and eyelid closure. Intact forehead function and involvement of the middle as well as lower parts of the face → central (supranuclear) lesion. Paralysis of the muscles of the mouth and cheeks. Important notice. The motor facial nuclei originate not only from the precentral … Facial Nerve Palsy: Symptoms, Complaints, Signs
Medical history (history of illness) represents an important component in the diagnosis of facial nerve palsy. Family history What is the general health of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Do you often go … Facial Nerve Palsy: Medical History
Cardiovascular (I00-I99). Apoplexy – Lesion of contralateral cortex or corticobulbar tracts after ischemic infarction. Psyche – nervous system (F00-F99; G00-G99). Frey’s syndrome (auriculotemporal syndrome) – usually triggered by irritation of the auriculotemporal nerve, reddening of the skin and increased sweating in the ear-sleep region. Hemispasm facialis – involuntary contractions of the facial mimic muscles (facial … Facial Nerve Palsy: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by facial nerve palsy: Eyes and eye appendages (H00-H59). Keratoconjunctivitis sicca (dry eye syndrome). Ulcus corneae (corneal ulcer) due toincomplete lid closure’ and pathologically altered tear film; bes. with hypesthesia (reduced sensitivity) of the cornea (about 10% of cases). Psyche – … Facial Nerve Palsy: Consequential Diseases
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Inspection of the face in its overall symmetry. [central (supranuclear) lesion of the VII cranial nerve → disturbance of … Facial Nerve Palsy: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar) Borrelia serology (see below Lyme disease) – to exclude neuroborreliosis. Laboratory parameters 2nd order – depending on the results of the history, physical examination and the obligatory laboratory parameters – for differential diagnostic … Facial Nerve Palsy: Test and Diagnosis
Therapy target Improvement of the symptomatology Therapy recommendations Therapy depends on the cause of the disease (borrelia e.g. antibiotics). Virostatics (agents that inhibit viral replication) are indicated only when varicella zoster virus (VZV) is the cause of facial paresis. In idiopathic peripheral facial nerve palsy, a so-called steroid shock therapy (prednisiolone/glucocorticoids) is given for 10 … Facial Nerve Palsy: Drug Therapy
Obligatory medical device diagnostics. Electroneurography (ENG)* – to measure nerve conduction velocity of motor and sensory pathways of peripheral nerves. Electromyography (EMG; measurement of electrical muscle activity)* . * In addition to the assessment of nerve function also suitable for the prognosis of facial reanimation. If the clinic is typical, this diagnostic is dispensable! Optional … Facial Nerve Palsy: Diagnostic Tests
Notice: Surgical decompression (reduction of pressure) is not recommended in the acute phase of the disease. There is no convincing evidence of success, and potential complications are severe. 1st order In severe form of facial nerve palsy, microsurgical reconstruction of the facial nerve may be indicated; cross-face nerve suture vs. hypoglossal facial jumper nerve suture … Facial Nerve Palsy: Surgical Therapy
