2 - ENT - Facial nerve palsy - Causes + Bell's palsy Flashcards Preview

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Flashcards in 2 - ENT - Facial nerve palsy - Causes + Bell's palsy Deck (14):
1

Children - two congenital causes + what else do they give

Moebius syndrome - bilateral VI and VII palsies
Hemifacial microsomia - hemifacial hypoplasia (mainly ears mouth) + VII palsy

2

Children - 3 acquired causes

forceps delivery - VII v superficial in younger people
chicken pox VZV
Acute otitis media

3

Adults - 4 groups of causes t

Peripheral causes

middle ear causes

Intratemporal causes

Intracranial causes

4

4 peripheral causes

Trauma
Iatrogenic - surgery
Tumours - parotid Ca
Inflammatory - sarcoidosis

5

5 middle ear causes

Trauma
Iatrogenic - any ear surgery
CHOLESTEATOMA
Infection
Tumours - eg SCC

6

Infection of middle ear causing VII palsy - what is an emergency? what could it be? 3 other infections?

emergency = discharging ear and facial palsy - may be infected cholesteatoma

Acute OM
Mastoiditis
Herpes zoster

7

What may happen with Herpes zoster infection of middle ear, to cause VII palsy

RAMSAY HUNT syndrome - reactivation of VZV in genticualte ganglion of VII - can affect VII > tinnitus, vertigo, deafness

8

Intratemporal causes of VII palsy

Trauma - eg transverse skull fracture
Tumours eg SCC, Cholesteatoma

9

Intracranial causes

Tumours
Iatrogenic - skull base surgery
Vascular -stroke
Neuro -MS

10

What tumours intracranially may result in VII palsy

facial nerve neuroma, acoustic neuroma, meningioma, neoplastic meningitis

11

Bell's palsy - incidence? how is it diagnosed?

diagnosis of exclusion - no CNS/ear pathology
~20 per 100000/y

12

Bell's palsy - cause?

VII nerve palsy - possibly by inflam oedema of nerve in facial canal
- due to virus HSV/VZV
- may be accompanied by demyelination

13

Bell's palsy - Sx

Very acute onset
normally unilateral
- mouth sagging
-drooling
- watering/dry eyes
- impaired expressions
- dropping of eye lids

14

Bell's - mgmt + prognosis

mgmt - early steroids, high dose antivirals possibly
Prog - recovery usually begins withing 2 months
- 1/3 recover
- 1/3 largely recover
- 1/3 permanent significant abnormalities

poor prog with age, pain, complete palsy

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