Facial nerve palsy

Question 1

What are the 5 branches of the facial nerve?

Answer 1

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

Question 2

What are the functions of the facial nerve?

Answer 2

Motor - muscles of facial expression, stapedius in inner ear and some muscles in the neck

Sensory - taste from the anterior 2/3rds of the tongue

Parasympathetic - supplies submandibular + sublingual salivary glands and the lacrimal glands.

Question 3

When will the forehead be spared in a facial nerve palsy?

Answer 3

Upper motor neurone lesion = stroke or tumours

Question 4

Why is the forehead spared in an upper motor neurone facial nerve palsy?

Answer 4

As each side of the forehead has bilateral innervation from upper motor neurones.

Question 5

What is bell’s palsy?

Answer 5

An idiopathic unilateral lower motor neurone, facial nerve palsy

Question 6

How is bell’s palsy managed?

Answer 6

Prednisolone (often 50mg for 10 days)

• lubricating eye drops may also help stop developing dry eye and exposure keratopathy.

Question 7

What are some causes of lower motor neurone facial nerve palsies?

Answer 7

Infections
- otitis media
- HIV
- varicella zoster (Ramsay hunt)

Systemic diseases
- diabetes
- sarcoidosis
- leukaemia
- MS
- Guillain-Barre

Tumours
- acoustic neurones
- parotid tumours
- cholesteatomas

Trauma
- directly to the nerve
- basal skull fractures

Question 8

What is Ramsay Hunt syndrome?

Answer 8

Where there is reactivation of varicella zoster virus in the facial nerve.
Causes a unilateral lower motor neurone facial nerve palsy.
Also a painful, tender vesicular rash (often around the ear).

Question 9

How is Ramsay Hunt syndrome managed?

Answer 9

• prednisolone
• aciclovir
• lubricating eye drops (+ refer to opthalm if hutchingsons sign / worries around vision)