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AUDE 5410 > Facial nerve disorder > Flashcards

Facial nerve disorder Flashcards

1
Q

what is somatic motor?

A

Innervation of skeletal muscles

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2
Q

what is visceral motor

A

Innervation of smooth muscles

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3
Q

what is Visceral sensory

A

Sensation from the viscera (includes taste and smell as they are associated with the digestive tract)

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4
Q

what is somatic sensory

A

Sensation from sensory organs, skin, skeletal muscles, and connective tissue

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5
Q

where does somatic motor inervate?

A

1) Muscles of facial expression
»>Example: Furrowing of the forehead, raising the eyebrow; pursing lips; closing eyes
2)Postauricular muscle
Responsible for PAM-post auricular muscle reflex
3)Stapedius muscle (responsible for the middle ear acoustic reflex)

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6
Q

where does Visceral motor innervation

A

Lacrimal (tear ducts) and salivary glands (submandibular and sublingual)

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7
Q

where does visceral sensory innervate ?

A

Taste in anterior 2/3 of the tongue (chorda tympani nerve)

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8
Q

where does somatic sensory innervation

A

Posterior EAC, concha, ear lobe, and deep parts of the face

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9
Q

cn 7 is what type of nerve ?

A

its a mixed nerve

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10
Q

where does cn 7 come from

A

the 2nd pharyngeal arch

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11
Q

where does the facial nerve originate from?

A

From its origin in the facial motor nucleus in the anterior pons

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12
Q

facial nerve are inserted in what?

A

insertion in the muscles of facial expression and the stapedius muscle

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13
Q

where does the intracranial segment comes from?

A

from the facial motor nucleus in the anterior pons

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14
Q

where does the intracranial segment exit from?

A

Exists the brainstem at the pontomedullary junction

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15
Q

where does the intracranial segment run through?

A

Courses through the cerebellopontine angle (CPA) to enter the internal auditory canal (IAC) or meatus

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16
Q

where is a common site for facial nerve to getting trapped

A

the fallopian canal

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17
Q

where does the intratemporal portion run thru?

A

-its part of the labyrinthine
Passes through narrowest part of the fallopian canal (bony canal in the temporal bone)

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18
Q

what is the most common pathology associated with intratemporal portion

A

temporal bone fractures & Bell’s palsy

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19
Q

what does the tympanic segment form?

A

It forms the superior aspect of the oval window niche

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20
Q

what is the site of lesion in tympanic segment?

A

The facial nerve is readily injured here in pathologic processes and during ME surgery

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21
Q

what does mastoid segment show? in term of its branching pattern

A

It shows variable branching patterns in the face
-its all over the place

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22
Q

what about the way cn 7 travels makes it vulnerable to

A

The course of the facial nerve makes it vulnerable to many neoplastic, traumatic, and infectious conditions.

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23
Q

what is osteopetrosis?

A

The AD genetic condition (also called Albers-SchÖnberg Disease) is present at birth with varying severity and is a milder form than the AR condition, which is more severe

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24
Q

how do the bones look like in osteopetrosis?

A

It is a bony dysplasia; the bones harden and become denser

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25
Q

What does osteopetrosis do in terms bone ?

A

Causes multiple cranial neuropathies because of bony obliteration of neural foramina with entrapment and compression of cranial nerves

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26
Q

what other cn can be involved with osteopetrosis?

A

CN II, V, VII, VIII
-Congenital facial paralysis
-Vision (even blindness) and hearing loss (even deafness) are common

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27
Q

what is the treatment of osteopetrosis?

A

-Symptomatic
-Facial nerve decompression if nerve entrapment and associated facial dysfunction

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28
Q

what is mobius syndrome ?

A

Rare congenital disorder associated with hypoplasia of 6th (Abducens – moves the eye laterally) and 7th (Facial) cranial nerve nuclei

29
Q

what can cause the mobius syndrome in the utero

A

Exposure in utero to teratogens such as :
1)Cocaine
2)Ergotamine
>Alkaloid used as a vasoconstrictor to treat migraine, induce childbirth, and prevent post-partum hemorrhage
3)Misoprostol (synthetic prostaglandin E1)
>Vasodilator used to prevent stomach ulcers & sometimes used as a treatment for tinnitus

30
Q

what are signs/symptoms of mobius syndrome?

A

-Congenital facial diplegia (bilateral facial paralysis)
-Associated CN VI unilateral or bilateral paralysis
-Other cranial nerve deficits
-Deformities of extremities
-Musculoskeletal deformities
Intellectual disability

31
Q

what are treatment of mobius

A

-Ophthalmologic consultation
-Nerve reconstructive surgery

32
Q

what is the diagnosis of bells palsy ?

A

-Onset of partial/total unilateral facial paralysis during a 48-hour period
-Fever and neck stiffness at the onset
-No hearing loss or vertigo
-No other cranial neuropathy
-Normal head and neck examination
-Drying of eye due to decreased eye closure and lack of lacrimation
-Rare cases of recurrence
-Some spontaneous recovery should be noted within 3 to 6 months in all patients

33
Q

what are the causes of bells palsy

A

Idiopathic (most common - diagnosis of exclusion)
Herpes simplex virus (main infectious agent)

34
Q

what are the time period of diagnosis for bells palsy?

A

-within 3 to 6 months of onset of paralysis
-Audiometric evaluation
-Testing for HIV and Lyme disease, if appropriate

35
Q

what test look normal in bells palsy

A

-Otoscopy – normal
-Pure-tone audiometry – hearing loss is rare
-Immittance audiometry - Normal tympanogram

36
Q

how do reflexes look like in bells palsy ?

A

-Abnormal ARTS due to a lesion proximal to the stapedius nerve
-Presence of ARTs indicates lesion distal to the stapedius nerve

37
Q

what are treatment of bells palsy ?

A

-Decompression of the nerve is indicated when > 90% degeneration occurs within 2 weeks of onset
»>Decompression involves relieving pressure on the nerve possibly by removing part of the surrounding bone
-Steroids indicated early in the course of the disease
-Acyclovir (antiviral) with steroids (inconsistent data re: benefits)
-Eye care to prevent permanent damage due to dryness of eye

38
Q

what is the differential diagnosis for bells palsy?

A

-CPA or skull-based tumors
-Vestibular schwannoma
-Otitis media
-Parotid gland tumors

39
Q

in bells palsy Good prognosis for recovery of function includes?

A

1)Younger patients
2)Partial paralysis and recovery of function within 2 months
3)Intact ARTs (lesion distal to stapedius nerve)
»>Lesion in the mastoid or extratemporal segment of the facial nerve
4)Electromyographic (EMG) evidence of voluntary activity
5)Electroneurography (ENoG) shows < 90% degeneration of electrically evoked muscle action potential after ~ two weeks of onset

40
Q

what is the prognosis of bells palsy?

A

Majority of patients recover function within 3 to 6 months with no medical or surgical intervention except eye care

41
Q

what are poor prognosis bells palsy

A

-Patients older than 65 years
-Greater than 90% nerve degeneration within the first two weeks as diagnosed with ENoG
-Diabetic patients
»»Who also show increased incidence/greater risk for Bell’s palsy because of a peripheral circulatory disorder that develops in the feeding vessels to the facial nerves

42
Q

what is the most common injury in temporal fractures ?

A

Most common site of injury is adjacent to the geniculate ganglion
Hearing loss (conductive, mixed or SNHL) is common

43
Q

what is the most common iatrogenic injury

A

-injury during surgical procedures
-The most common site of injury is the tympanic segment over the oval window; e.g., injury during otosclerosis and cholesteatoma surgery

44
Q

what are lacerations

A

Facial nerve grafting after penetrating trauma to the nerve

45
Q

what are treatments for malignant otitis externa

A

-Debridement of infected tissue
-Decompression of facial nerve when needed
-Antibiotics

46
Q

facial paralysis is secondary to what ?

A

inflammatory ME disease

47
Q

what causes acute suppurative otitis media

A

Caused by gram-positive bacteria and Haemophilus influenzae

48
Q

what is the invasion of Acute suppurative otitis media

A

-Invasion into the facial canal through a dehiscence may evoke an inflammatory response with edema, compression, and ischemia resulting in facial weakness
»>Dehiscence is the erosion of or discontinuity in the bony structure of the facial canal, allowing for communication between the facial nerve and the middle ear cavity

49
Q

what is the treatment for acute suppurative otitis media

A

-Myringotomy
-Appropriate antibiotics
-Trans-mastoid decompression if nerve degeneration is progressive

50
Q

is facial paralysis a secondary symptom for chronic otitis media

A

yes!
-Paralysis can occur with or without cholesteatoma

51
Q

what is the treatment of chronic otitis media

A

-This condition is an urgent indication for surgical intervention
-Tympano-mastoidectomy is appropriate for the chronic ear infection followed by decompression of involved facial nerve
-Removal of cholesteatoma, if present, adherent to the nerve

52
Q

what are signs and symptoms of Herpes zoster oticus (Ramsay-Hunt Syndrome)

A

-Otalgia and severe pain
-Vesicular eruption on the concha and/or external canal and along the sensory distribution of 7th cranial nerve
-Facial paralysis that tends to be more severe
-Hearing loss
-Vertigo
-Higher frequency of complete degeneration of the facial nerve

53
Q

what are the site of lesions in herpes?

A

-Labyrinthine segment of the facial nerve
-Can involve CNs V, IX, X, XI
-Herpes zoster cephalicus, which is rare and involves cervical dermatomes (skin areas)

54
Q

what is the medication used for herpes

A

Acyclovir

55
Q

what are symptoms seen in facial neuromas

A

1)facial weakness
2)HL
3)Tinnitus
4)Otorrhea
5)Ear canal mass
6)Otalgia
7)Vestibular symptoms

56
Q

what are facial neuromas/schwannomas?

A

rare benign neoplasms of schwann cells

57
Q

where are the majority of facial neuromas located ?

A

the tympanic area

58
Q

if the tumor isn’t trapped in the IAC or CPA then what symptoms may we not see

A

, no facial symptoms maybe present

59
Q

why might vestibular schwannomas be misdiagnosed

A

Misdiagnosis is then common especially with vestibular schwannoma because of the SNHL, which is often present in such cases – ARTs can be helpful for differential diagnosis

60
Q

how might pure tones look like in facial neuroma ?

A

SNHL due to cochlear nerve compression by the tumor

61
Q

how might tymps look like in facial neuromas

A

normal

62
Q

how might reflexes look like in facial neuroma ?

A

-Abnormal ARTS due to a lesion proximal to the stapedius nerve
-Presence of ARTs indicates lesion distal to the stapedius nerve

63
Q

how might Electroneurography (ENoG) look like in facial neuromas

A

ENoG can be normal in cases of VII N tumors located primarily in the CPA that may cause a hearing loss but do not affect facial function

64
Q

what will determine if the tumor is acoustic or facial?

A

ABR

65
Q

what is something important to remember with stapedius branch of facial nerve

A

-Abnormal ARTS if a lesion is proximal to the stapedius nerve
-ARTs present if a lesion is distal to the stapedius nerve

66
Q

look at slide 39, it’s super important

A
67
Q

look at slide 40

A
68
Q

what are differential diagnosis for facial neuroma

A

1)Otitis media with conductive hearing loss
>With or without cholsteatoma
2)Cholesteatoma
>Requires prompt decompression of the VII N and resection of the cholestatoma
3)Glomus tumor (Paragangliommas – ME & jugular vein bulb)
4)Meningiomas
>Tumor of the meninges
5)Acoustic neuroma (vestibular schwannoma)
>Both VII and VIII nerve schwannomas have been reported in some cases of NF2

69
Q
A

AUDE 5410 (9 decks)

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