Medical knowledge | Otorhinolaryngology, ear, nose, throat » Dr. Ágnes Szirmai - Peripheral facial palsy

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Source: http://www.doksinet Ágnes Szirmai MD, PhD. Source: http://www.doksinet ™Supranuclear pathways ™Pontine nuclei ™Intracranial part ™Extracranial, intratemporal part (Fallopian canal) ™Extratemporal part Source: http://www.doksinet ™ Distorting, visible disease ™ Severe inconvenience in everyday life (eating, socialisation, mood) ™ Many causes –severe diseases Source: http://www.doksinet ™No wrinkles on face, on forehead ™No eye-closure, Bell’s phenomenon ™No movements on face ™Nasolabial assymmetry ™Lacrimation or dry eye ™ Hyperacusia, ™Tasting disorder Source: http://www.doksinet Types of palsy: ™ Central, supranuclearperiorbital and temporal muscles are working ™ Peripheral, nuclear- all branches of nerve Severity of palsy: ™ Incomplete – mild movements ™ Complete palsy- no movement at all Source: http://www.doksinet (based on electrodiagnostic tests) ™ Neurapraxia: no movement, but electric function is measurable ™ Axonotmesis:

no movement, electric reflectivity is absent, perineurium is normalspontaneous regeneration is possible ™ Neurotmesis: no movement, electric reflectivity is absent, perineurium is distroyedspontaneous regeneration is impossible (anatomical lesion) Source: http://www.doksinet ™Developmental disorders ™Traumas ™Infections ™Tumours ™Bell’s palsy (idiopathic) Source: http://www.doksinet Bilateral absence of facial nuclei Sleeping Crying Laughing Source: http://www.doksinet Pyramid bone fracture ™ Transversal fracture ™ Prompt palsy – lesion of nerve ™ Longitudinal fracture ™ Prompt palsy – lesion of nerve ™ Delayed palsy- perifocal edema Other traumas: ™ Traumas of the face ™ Iatrogenic traumas during ear, or parotid surgery Source: http://www.doksinet Bacterial infections: Mostly complication of acute or chronic middle ear infections ™ Lyme borreliosis: Tick’s bite in case history, erythema migrans ™ ™ Viral infection: Influenza, herpes

simplex, herpes zoster oticus Source: http://www.doksinet ™ Brain stem tumours Other neurological symptoms, e.g abducent nerve palsy ™ Pontocerebellar and intrameatal tumours Cochleovestibular symptoms ™ Middle ear tumours Facial palsy is a late symptom ™ Parotid gland tumour Palsy occurred only in malignant tumours Source: http://www.doksinet Source: http://www.doksinet ™Sudden onset, without causes ™Edema of nerve>compression > hypoxia > increasing edema > increasing compression in Fallopian canal >impaired function ™E.g local cooling ™Diagnostic procedure: exclusion of other diseases ™Prognostical prediction: after a week Source: http://www.doksinet ™ Otoscopy ™ Audiometry, tympanometry, stapedial reflex ™ Imaging methods (Schüller, CT, MR) ™ Parotid gland palpation (ultrasonography) ™ Blood tests (diabetes!), blood pressure ™Topical diagnosis ™ n. petrosus- lacrimation -Shirmer teszt ™ n. stapedius-hyperacusis- stapedial reflex ™ chorda

tympani –tasting disorders- gustometria ™Electrodiagnostic tests Source: http://www.doksinet In every palsy case: ™Psychical support of patients ™Ophthalmological control (keratitis) ™Covering the eye-ball, eyedrops ™Electrotherapy, selective stimulation of the nerve or the muscles to prevent atrophy. ™In the recovery stadium -active movement . Source: http://www.doksinet Medical treatment: ™ Corticosteroids (if no contraindications) ™ Vitamin B , antihistamins, antiviral drugs (acyclovir) Surgery: ™ Decompression- Fallopian canal opening-if no regeneration- after 3 months ™ After complete axonotmesis no complete recovery Source: http://www.doksinet ™Headache is the most common complaint. ™Most of the cases have common cause. ™Sometimes diagnosis is a long and difficult procedure. Ear-nose-throat diseases can cause headache! Source: http://www.doksinet ™ Primary headaches Migraine, tension headache, cluster headache, chronic paroxysmal hemicrania ™

Secondary headaches ™ Headaches due to neurological reasons Posttraumatic, vascular, infectious headaches, metabolic headaches ™ Otolaryngolocical and ophthalmological headaches ™ Neuralgias Source: http://www.doksinet ™Diseases of nasal and paranasal sinuses ™Nasopharyngeal diseases ™Outer and middle ear diseases Source: http://www.doksinet Localisation of pain ™Forehead ™Face ™Top of the head ™Periorbital Types of headache ™Pulsating ™Pressure, tension Source: http://www.doksinet ™ ™ ™ ™ Pain on forehead: Frontal or maxillar sinusitis, nose breathing problems (e.g septal deviation) Facial pain: maxillary sinusitis, closure of semilunar hiatus (e.g nasal polyps) Pain on the top of head: sphenoid sinusitis Periorbital pain: ethmoiditis, complications of sinusitis Source: http://www.doksinet ™ ™ ™ ™ Type of headache: tension, pressure Concomittant symptoms: nose breathing problems, mucoid discharge Drainage decreases the pain Pathomechanism of

pain: ostiomeatal unit closure Source: http://www.doksinet Mild pressure of forehead or/and face Concomittant symptoms: ™ Nasal breathing problems ™ Odorous discharge ™ Nose bleeding ™ Occlusion disorders ™ Facial assymmetry ™ Eye movement disorders because of eye ball displacement Source: http://www.doksinet ™ Orbital cellulitis ™ Orbital abscess ™ Osteomyelitis ™ Thrombophlebitis of cavernosal sinus ™ Meningitis ™ Brain-abscess Source: http://www.doksinet (adenoids, nasopharyngeal tumours) Mild pain (nuchal region and/or top of the head) Concommitant symptoms: ™ Nasal breathing problems ™ Conductive hearing loss ™ Retronasal discharge ™ Posterior nose bleeding Source: http://www.doksinet ™ Outer ear disorders: usually earache ™ Pressure: wax in the external meatus ™ Pulsating pain: external otitis ™ Neuralgiform pain: herpes zoster ™ Middle ear diseases: usually earache ™ Pulsating pain: acute, purulent middle ear inflammation ™ Mild headache is

rare, usually caused by cholesteatoma ™ Complications of middle ear inflammatory diseases ™ Inner ear diseases: ™ No headaches Temporomandibular joint disorders (Costen syndrome): Unilateral headache, earache, chewing problems Source: http://www.doksinet ™ Mastoiditis ™ Subperiosteal abscess ™ Labyrinthitis ™ Peripheral facial palsy ™ Thrombosis of sigmoideal sinus ™ Petrositis ™ Meningitis ™ Brain abscess Source: http://www.doksinet ™Evaluation of headache provoking diseases ™Adequate treatment of causing diseases ™Adaquate medication of pain Source: http://www.doksinet