Facial Nerve- Examination and problems

Question 1

What should be checked when examining facial nerve function? What should you ask patients to do?

Answer 1

Raise eyebrows
Close eyes tightly (try to open them to assess power)
Bear teeth
Puff cheeks (attempt to flatten these)
Smile

Also ask about altered taste and sounds sounding louder than usual

Question 2

Compare the features of an UMN and a LMN facial nerve lesion

Answer 2

UMN- there is sparing of the upper quadrant. Patients can raise their eyebrows, close their eyes closely. (Innervation is bilateral)

LMN- the entire side of the face is weak

Question 3

What are the 5 branches of the facial nerve that innervate the facial muscles?

Answer 3

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

To zanzibar by motor car

Question 4

What are some intracranial causes of facial nerve palsy?

Answer 4

Stroke
Tumour
Multiple sclerosis
Meningitis
Acoustic neuroma

Question 5

What are some intratemporal causes of facial nerve palsy?

Answer 5

Otitis media
Cholesteatoma
Ramsay- Hunt Syndrome (Herpes zoster oticus)

Question 6

What are so infratemporal causes of facial nerve palsy?

Answer 6

Parotid tumours

Trauma

Question 7

What is a leading cause of facial nerve palsy?

Answer 7

Bell’s Palsy- causes around 70% of facial nerve paralysis

Question 8

Where does the facial nerve exit?

Answer 8

Stylomastoid foramen

Question 9

Where could you easily palpate that if there is a tumour it could cause facial nerve paralysis?

Answer 9

Parotid tumours

Question 10

What two factors increase someone’s risk of developing Bell’s palsy?

Answer 10

Pregnancy (3x)

Diabetes (5x)

Question 11

What are the features of Bell’s Palsy?

Answer 11

Weakness on the entire affected side
inability to close the eye
Drooping of the mouth
Drooling of saliva
Dryness of eye (facial nerve innervates lacrimal glands)
Altered taste
Sounds are louder (hyperacusis)

Question 12

What is the treatment for Bells Palsy?

Answer 12

Prednisolone has been found to be effective

Eye protection is important- eye drops, ointments, taping the lid shut. Consider ophthalmology input if cornea is exposed when attempting to close the eye.

Question 13

When should suspected Bell’s Palsy be referred to ENT?

Answer 13

Diagnostic uncertainty
Recurrent Bell’s Palsy
Paralysis shows no improvement after 1 month