598:. Facial palsy is considered severe if the person is unable to close the affected eye completely or the face is asymmetric even at rest. Corticosteroids initiated within three days of Bell's palsy onset have been found to increase chances of recovery, reduce time to recovery, and reduce residual symptoms in case of incomplete recovery. However, for facial palsy caused by Lyme disease, corticosteroids have been found in some studies to harm outcomes. Other studies have found antivirals to possibly improve outcomes relative to corticosteroids alone for severe Bell's palsy. In those whose blinking is disrupted by the facial palsy, frequent use of artificial tears while awake is recommended, along with ointment and a patch or taping the eye closed when sleeping. Several surgical treatment options exist to restore symmetry to the paralyzed face in patients where function does not return (see section Tumors above).
381:
facial nerve, while malignant tumors should always be resected along with large areas of tissue around them, including the facial nerve. While this will inevitably lead to facial paralysis, safe removal of a malignant neoplasm is vital for patient survival. After tumor removal, the facial nerve can be reinnervated with techniques such as cross-facial nerve grafting, nerve transfers and end-to-end nerve repair. Alternative treatment methods include muscle transfer techniques, such as the gracilis free muscle transfer or static procedures.
528:
502:. Otherwise, the diagnosis is peripheral facial palsy, and its cause needs to be identified, if possible. Ramsey Hunt's syndrome causes pain and small blisters in the ear on the same side as the palsy. Otitis media, trauma, or post-surgical complications may alternatively become apparent from history and physical examination. If there is a history of trauma, or a tumour is suspected, a
53:
384:
Patients with facial nerve paralysis resulting from tumours usually present with a progressive, twitching paralysis, other neurological signs, or a recurrent Bell's palsy-type presentation. The latter should always be suspicious, as Bell's palsy should not recur. A chronically discharging ear must be
270:
has formed as this must be removed if present. Inflammation from the middle ear can spread to the canalis facialis of the temporal bone - through this canal travels the facial nerve together with the statoacoustisus nerve. In the case of inflammation the nerve is exposed to edema and subsequent high
518:
should be estimated, based on recent history of outdoor activities in likely tick habitats during warmer months, recent history of rash or symptoms such as headache and fever, and whether the palsy affects both sides of the face (much more common in Lyme than in Bell's palsy). If that likelihood is
469:
is a bilateral facial paralysis resulting from the underdevelopment of the VII cranial nerve (facial nerve), which is present at birth. The VI cranial nerve, which controls lateral eye movement, is also affected, so people with
Moebius syndrome cannot form facial expression or move their eyes from
380:
Often, since facial neoplasms have such an intimate relationship with the facial nerve, removing tumors in this region becomes perplexing as the physician is unsure how to manage the tumor without causing even more palsy. Typically, benign tumors should be removed in a fashion that preserves the
337:
and wait. In patients with severe injury, progress is followed with nerve conduction studies. If nerve conduction studies show a large (>90%) change in nerve conduction, the nerve should be decompressed. The facial paralysis can follow immediately the trauma due to direct damage to the facial
208:
that may be accompanied by headaches, body aches, fatigue, or fever. In up to 10-15% of Lyme infections, facial palsy appears several weeks later, and may be the first sign of infection that is noticed, as the Lyme rash typically does not itch and is not painful. Lyme disease is treated with
158:
infection. Bell's palsy may develop over several days, and may last several months, in the majority of cases recovering spontaneously. It is typically diagnosed clinically, in patients with no risk factors for other causes, without vesicles in the ear, and with no other
299:, may also cause acute facial nerve paralysis. Understandably, the likelihood of facial paralysis after trauma depends on the location of the trauma. Most commonly, facial paralysis follows temporal bone fractures, though the likelihood depends on the type of fracture.
1231:
538:
Facial nerve paralysis may be divided into supranuclear and infranuclear lesions. In a clinical setting, other commonly used classifications include: intra-cranial and extra-cranial; acute, subacute and chronic duration.
494:, are needed for diagnosis. The first step is to observe what parts of the face do not move normally when the person tries to smile, blink, or raise the eyebrows. If the forehead wrinkles normally, a diagnosis of
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1416:
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nerve, in such cases a surgical treatment may be attempted. In other cases the facial paralysis can occur a long time after the trauma due to oedema and inflammation. In those cases steroids can be a good help.
606:
A study followed thirty individuals with facial paralysis following a stroke. Six months after the onset of paralysis, two-thirds of the patients had fully recovered or only had mild facial paralysis.
1074:
Thompson AL, Bharatha A, Aviv RI, Nedzelski J, Chen J, Bilbao JM, Wong J, Saad R, Symons SP (July 2009). "Chondromyoid fibroma of the mastoid facial nerve canal mimicking a facial nerve schwannoma".
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more than negligible, a serological test for Lyme disease should be performed. If the test is positive, the diagnosis is Lyme disease. If no cause is found, the diagnosis is Bell's Palsy.
973:
305:
in the horizontal plane present the highest likelihood of facial paralysis (40-50%). Patients may also present with blood behind the tympanic membrane, sensory deafness, and
389:
exploration. Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumour, and it should be managed accordingly.
103:. The pathway of the facial nerve is long and relatively convoluted, so there are a number of causes that may result in facial nerve paralysis. The most common is
594:, and reevaluated upon completion of laboratory tests for Lyme disease. All other patients should be treated with corticosteroids and, if the palsy is severe,
423:. Unlike peripheral facial palsy, central facial palsy does not affect the forehead, because the forehead is served by nerves coming from both motor cortexes.
582:
If an underlying cause has been found for the facial palsy, it should be treated. If it is estimated that the likelihood that the facial palsy is caused by
1232:"Dynamic Reanimation of Smile in Facial Paralysis with Gracilis Functioning Free Muscle Flap Innervated by Masseteric Nerve: The First Vietnamese Series"
154:
Bell's palsy is the most common cause of acute facial nerve paralysis. There is no known cause of Bell's palsy, although it has been associated with
204:, but it is expanding into other areas. The first sign of about 80% of Lyme infections, typically one or two weeks after a tick bite, is usually an
351:
1531:
1216:
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216:, as well as being associated with Bell's palsy, may also be a direct cause of facial nerve palsy. Reactivation of latent virus within the
1311:"[Treatment of central facial nerve paralysis with electromyography biofeedback and taping of cheek. A controlled clinical trial]"
115:
Facial nerve paralysis is characterised by facial weakness, usually only in one side of the face, with other symptoms possibly including
742:
1014:
246:
is an infection in the middle ear, which can spread to the facial nerve and inflame it, causing compression of the nerve in its canal.
188:, can account for about 25% of cases of facial palsy in areas where Lyme disease is common. In the U.S., Lyme is most common in the
135:. Symptoms may develop over several hours. Acute facial pain radiating from the ear may precede the onset of other symptoms.
1185:
813:
770:
258:) or decompression if the patient does not improve. Chronic otitis media usually presents in an ear with chronic discharge (
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1524:
473:
Facial piercings, namely eyebrow piercings or tongue piercings, can in very rare cases cause damage to the facial nerve.
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317:
in the vertical plane present a lower likelihood of paralysis (20%). Patients may present with blood coming out of the
350:
compressing the facial nerve anywhere along its complex pathway can result in facial paralysis. Common culprits are
17:
1283:
1117:
Thompson AL, Aviv RI, Chen JM, Nedzelski JM, Yuen HW, Fox AJ, Bharatha A, Bartlett ES, Symons SP (December 2009).
163:. Recovery may be delayed in the elderly, or those with a complete paralysis. Bell's palsy is often treated with
1517:
452:
613:. Additionally, the majority of individuals begin to recover within seven days after the onset of paralysis.
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1798:
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221:
1772:
225:
1031:
Cools MJ, Carneiro KA (April 2018). "Facial nerve palsy following mild mastoid trauma on trampoline".
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107:, a disease of unknown cause that may only be diagnosed by exclusion of identifiable serious causes.
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160:
333:. In patients with mild injuries, management is the same as with Bell's palsy – protect the
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may be ordered depending on suspected causes. The likelihood that the facial palsy is caused by
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547:
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404:
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8:
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side to side. Moebius syndrome is extremely rare, and its cause or causes are not known.
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Fuller, G; Morgan, C (31 March 2016). "Bell's palsy syndrome: mimics and chameleons".
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766:
765:. illust. Robert Britton (21st ed.). Edinburgh: Churchill Livingstone/Elsevier.
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and tear secretion. Other signs may be linked to the cause of the paralysis, such as
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266:). Once suspected, there should be immediate surgical exploration to determine if a
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treated as a cholesteatoma until proven otherwise; hence, there must be immediate
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224:. In addition to facial paralysis, symptoms may include ear pain and vesicles,
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In the case of Bell's palsy, 71% of individuals fully recover without any
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Facial nerve paralysis, sometimes bilateral, is a common manifestation of
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120:
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52:
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Colledge, Nicki R.; Walker, Brian R.; Ralston, Stuart H., eds. (2010).
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are used to control the otitis media, and other options include a wide
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124:
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Primary Care ENT, An Issue of
Primary Care: Clinics in Office Practice
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Infranuclear lesions refer to the majority of causes of facial palsy.
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96:
84:
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Svensson, B. H.; Christiansen, L. S.; Jepsen, E. (7 December 1992).
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Facial palsy : techniques for reanimation of the paralyzed face
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132:
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566:. These are corticobulbar fibers travelling in internal capsule.
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is associated with vesicles affecting the ear canal, and termed
1420:
511:
499:
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347:
185:
1348:
Holland, N. Julian; Bernstein, Jonathan M. (9 April 2014).
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Bui, Mai-Anh; Goh, Raymond; Vu, Trung-Truc (11 July 2019).
72:
68:
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936:
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in the ear, which may occur if the facial palsy is due to
1166:
RodrĂguez-Lorenzo, AndrĂ©s; Tzou, Chieh-Han, eds. (2021).
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937:
Wright WF, Riedel DJ, Talwani R, Gilliam BL (June 2012).
507:
1165:
760:
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1281:
542:
510:may be used to clarify its impact. Blood tests or
1785:
1347:
1272:The Plastics Fella Guide to Facial Nerve Anatomy
808:(17th ed.). New York: McGraw-Hill Medical.
498:is made, and the person should be evaluated for
283:, the facial nerve is the most commonly injured
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271:pressure, resulting in a periferic type palsy.
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763:Davidson's principles and practice of medicine
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590:with antibiotics should be initiated, without
451:Bilateral facial nerve paralysis may occur in
262:), or hearing loss, with or without ear pain (
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918:. Centers for Disease Control and Prevention
892:. Centers for Disease Control and Prevention
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63:representation of facial paralysis. 300 AD,
27:Loss of motor function in the facial muscles
930:
715:
309:; the latter two symptoms due to damage to
1532:
1518:
1215:: CS1 maint: location missing publisher (
939:"Diagnosis and management of Lyme disease"
806:Harrison's principles of internal medicine
562:itself can be affected by infarcts of the
419:itself can be affected by infarcts of the
51:
1539:
1373:
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1247:
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1000:
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822:
731:. Elsevier Health Sciences. p. 138.
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1236:International Microsurgery Journal (Imj)
1229:
965:
526:
1119:"MR imaging of facial nerve schwannoma"
971:
961:from the original on 27 September 2013.
724:
569:
14:
1786:
1282:Michelle Stephenson (4 October 2012).
669:
95:is a common problem that involves the
1513:
912:"Lyme disease rashes and look-alikes"
110:
1284:"OTC Drops: Telling the Tears Apart"
886:"Lyme Disease Data and surveillance"
745:from the original on 20 August 2016.
99:of any structures innervated by the
1794:Peripheral nervous system disorders
981:The New England Journal of Medicine
24:
846:"Managing Peripheral Facial Palsy"
25:
1815:
1394:
974:"Clinical practice. Lyme disease"
863:10.1016/j.annemergmed.2017.08.039
844:Garro A, Nigrovic LE (May 2018).
522:
1290:. Jobson Medical Information LLC
1249:10.24983/scitemed.imj.2019.00116
804:; Harrison, T. R., eds. (2008).
543:Supranuclear and nuclear lesions
392:Other neoplastic causes include
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1302:
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1223:
1159:
1110:
1067:
693:10.1136/practneurol-2016-001383
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13:
1:
616:
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394:leptomeningeal carcinomatosis
850:Annals of Emergency Medicine
577:
477:
170:
7:
222:Ramsay Hunt syndrome type 2
46:Facial palsy, prosopoplegia
10:
1820:
1773:Cavernous sinus thrombosis
1045:10.1016/j.ajem.2018.04.034
725:Dickson, Gretchen (2014).
558:going to the nucleus. The
431:Other causes may include:
415:going to the nucleus. The
226:sensorineural hearing loss
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1178:10.1007/978-3-030-50784-8
943:American Family Physician
461:peripheral nervous system
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341:
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178:, an infection caused by
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78:
59:
50:
42:
37:
1768:Jugular foramen syndrome
1732:Accessory nerve disorder
554:affecting fibers in the
492:neurological examination
426:
411:affecting fibers in the
319:external auditory meatus
972:Shapiro ED (May 2014).
453:Guillain–Barré syndrome
444:of the nervous system,
331:conductive hearing loss
327:external auditory canal
311:vestibulocochlear nerve
184:bacteria and spread by
65:Larco Museum Collection
1664:Facial nerve paralysis
1587:Oculomotor nerve palsy
1288:Review of Ophtalmology
1039:(8): 1522.e1–1522.e3.
535:
232:. Management includes
214:varicella zoster virus
93:Facial nerve paralysis
38:Facial nerve paralysis
1605:Trochlear nerve palsy
1541:Cranial nerve disease
1354:BMJ Clinical Evidence
1172:. Cham, Switzerland.
993:10.1056/NEJMcp1314325
530:
315:Longitudinal fracture
1659:Central facial palsy
1641:Abducens nerve palsy
1623:Trigeminal neuralgia
1315:Ugeskrift for Laeger
570:Infranuclear lesions
548:Central facial palsy
496:central facial palsy
488:physical examination
405:Central facial palsy
303:Transverse fractures
254:(an incision in the
196:states and parts of
181:Borrelia burgdorferi
125:decreased salivation
1799:Otorhinolaryngology
1020:on 19 October 2016.
681:Practical Neurology
635:The Free Dictionary
550:can be caused by a
407:can be caused by a
313:and the inner ear.
218:geniculate ganglion
1756:Combined syndromes
1473:External resources
1136:10.1002/lary.20644
1088:10.1002/lary.20486
536:
377:of other tumours.
325:tear, fracture of
161:neurological signs
111:Signs and symptoms
1781:
1780:
1679:Vestibulocochlear
1507:
1506:
1321:(50): 3593–3596.
1187:978-3-030-50784-8
1129:(12): 2428–2436.
987:(18): 1724–1731.
815:978-0-07-147693-5
802:Fauci, Anthony S.
772:978-0-7020-3084-0
459:condition of the
436:Diabetes mellitus
364:acoustic neuromas
323:tympanic membrane
256:tympanic membrane
90:
89:
32:Medical condition
16:(Redirected from
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564:pontine arteries
556:internal capsule
467:Moebius syndrome
446:neurosarcoidosis
421:pontine arteries
413:internal capsule
212:Reactivation of
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18:Facial paralysis
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588:empiric therapy
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552:lacunar infarct
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409:lacunar infarct
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352:facial neuromas
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289:Physical trauma
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234:antiviral drugs
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165:corticosteroids
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1403:Classification
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1350:"Bell's palsy"
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1033:Am J Emerg Med
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856:(5): 618–623.
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738:978-0323287173
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656:"Facial Nerve"
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560:facial nucleus
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523:Classification
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490:, including a
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417:facial nucleus
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356:cholesteatomas
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206:expanding rash
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156:herpes simplex
148:Main article:
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294:
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290:
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282:
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268:cholesteatoma
265:
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108:
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62:
61:Moche culture
58:
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1763:Bulbar palsy
1669:Bell's palsy
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1123:Laryngoscope
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516:Lyme disease
481:
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281:blunt trauma
278:
244:Otitis media
242:
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194:Mid-Atlantic
179:
176:Lyme disease
174:
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150:Bell's palsy
144:Bell's palsy
114:
105:Bell's palsy
101:facial nerve
92:
91:
29:
1742:Hypoglossal
1498:plastic/522
1482:MedlinePlus
661:22 November
442:sarcoidosis
360:hemangiomas
252:myringotomy
248:Antibiotics
190:New England
121:hyperacusis
43:Other names
1788:Categories
1615:Trigeminal
1579:Oculomotor
1201:11 October
617:References
602:Prognostic
596:antivirals
457:autoimmune
375:metastases
1724:Accessory
1597:Trochlear
1549:Olfactory
1493:eMedicine
1458:SNOMED CT
1366:1752-8526
1327:0041-5782
1258:199045428
1211:cite book
1196:235205923
640:1 January
578:Treatment
478:Diagnosis
371:neoplasms
293:fractures
236:and oral
202:Minnesota
198:Wisconsin
171:Infection
97:paralysis
85:Neurology
80:Specialty
1633:Abducens
1463:46382007
1384:24717284
1360:: 1204.
1294:16 April
1153:24237419
1145:19780031
1104:34800452
1096:19507235
1061:44106089
1053:29861376
1011:24785207
959:Archived
955:22962880
922:18 April
896:12 April
872:29110887
743:Archived
701:27034243
611:sequelae
387:surgical
260:otorrhea
238:steroids
133:shingles
129:vesicles
1452:D005158
1375:3980711
1335:1471279
1002:4487875
709:4480197
504:CT scan
307:vertigo
295:of the
264:otalgia
230:vertigo
1651:Facial
1487:003028
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512:x-rays
500:stroke
400:Stroke
342:Tumors
329:, and
275:Trauma
228:, and
139:Causes
1709:Vagus
1564:Optic
1254:S2CID
1242:(2).
1192:S2CID
1149:S2CID
1100:S2CID
1057:S2CID
1018:(PDF)
977:(PDF)
705:S2CID
455:, an
427:Other
373:, or
348:tumor
186:ticks
1804:Face
1447:MeSH
1436:9-CM
1380:PMID
1362:ISSN
1358:2014
1331:PMID
1323:ISSN
1296:2019
1217:link
1203:2022
1182:ISBN
1141:PMID
1092:PMID
1049:PMID
1007:PMID
951:PMID
924:2019
898:2019
868:PMID
810:ISBN
767:ISBN
733:ISBN
697:PMID
663:2009
642:2018
531:The
486:and
335:eyes
200:and
192:and
123:and
73:Peru
69:Lima
1441:351
1432:ICD
1426:G51
1417:ICD
1370:PMC
1319:154
1244:doi
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