Facial Palsy

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Clinically Relevant Anatomy

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Mechanism of Injury / Pathological Process

Causes of Facial Palsy:

• Idiopathic/viral

Bell's Palsy (linked to Herpes Simplex infection)

Ramsey Hunt Syndrome (linkied to Herpes Zoster infection)

• Tumour

A tumor compressing the facial nerve can result in facial paralysis, but more commonly the facial nerve is damaged during surgical removal of a tumour. The most common tumour to result in facial palsy during surgical removal is the Acoustic Neuroma (AKA Vestibular Schwannoma). Less commonly, cholesteatoma, hemangioma, Facial Neuroma or partotid gland tumours are the cause.

• Rare causes include

Neurosarcoidosis, ototis media, Multiple Sclerosis, Moebius Syndrome

• The facial nerve can also be damaged by trauma, especially temporal bone fractures

Clinical Presentation

Paralysis of the muscles supplied by the Facial Nerve presents on the affected side of the face as follows:

Appearance and range of movement:

Inability to close the eye

Inability to move the lips eg. into smile, pucker

At rest, the affected side of the face may "droop"

Functional effects:

Difficulty eating and drinking as lack of lip seal makes it difficult to keep fluids and food in the oral cavity

Reduced clarity of speech as the "labial consonents" (ie. b, p, m, v, f) all require lip seal 

Differential Diagnosis, UMN versus LMN:

If the forehead is not affected (ie the patient is able to raise fully the eyebrow on the affected side) then the facial palsy is likely to be a result of a lesion in the Upper Motor Neuron (UMN). Paralysis which includes the forehead, such that the patient is unable to raise the affected eyebrow, is a Lower Motor Neuron (LMN)lesion.

Diagnostic Procedures

Laboratory investigations include an audiogram, nerve conduction studies (ENoG), computed tomography (CT) or magnetic resonance imaging (MRI), electromyography (EMG).

Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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Resources

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