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Encyclopedia > Facial paralysis

Acute facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. The pathway of the facial nerve is long and relatively convoluted, and so there are a number of causes that may result in facial nerve paralysis. The most common is Bell's palsy, an idiopathic disease that may only be diagnosed by exclusion. Paralysis is the complete loss of muscle function for one or more muscle groups. ... The facial nerve is seventh of twelve paired cranial nerves. ... Bells palsy (facial palsy) is characterised by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ...


A thorough medical history and physical examination are the first steps in making a diagnosis. The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ...


During the physical examination, a distinction must first be made between paralysis and paresis (incomplete paralysis). Not surprisingly, paralysis is far more serious and requires immediate treatment. It must also decide whether the forehead is involved in the motor defect or not. This is usually accomplished by assessing how well a patient can raise her eyebrows. The question is an important one because it helps determine if the lesion is in the upper motor neuron component of the facial nerve, or in its lower motor neuron component. Paresis is a condition typified by partial loss of movement, or impaired movement. ... Treatment may refer to: // Health Therapy - the act of remediation of a health problem. ... Sebastian Sznitka ... The eyebrow is a bony ridge above the eye that protects the eye and bears a tuft of facial hair in most mammals. ... Upper motor neurons, or Betz cells, are motoneurons located in the primary motor cortex. ... Lower motor neurons (LMNs) are the motoneurons connecting the brainstem and spinal cord to muscle fibers, bringing the nerve impulses from the upper motor neurons out to the muscles. ...


Laboratory investigations include an audiogram, nerve conduction studies (ENoG), computed tomography (CT) or magnetic resonance (MR) imaging. An Audiogram is a graphical representation of how well a certain person can perceive different sound frequencies. ... A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. ... This article does not cite its references or sources. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ...

Contents

Causes

Bell's palsy

Bell's palsy, an idiopathic condition, is by definition a diagnosis of exclusion, but is still the most common cause of acute facial nerve paralysis (>80%). Some factors that tend to rule out Bell's palsy include: Bells palsy (facial palsy) is characterised by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ...

  1. Recurrent paralysis
  2. Slowly progressive paralysis (Bell's palsy onsets very suddenly)
  3. Twitching
  4. Associated symptoms (either cochlear or neurologic)
  5. No return of function in 6 months (Bell's palsy is normally short-lived).

Bell's palsy is believed in the most recent studies to be due to herpes virus. Other proposed etiologies include vascular problems in the inner ear. Treatment include steroids and antivirals. Cross section of the cochlea. ... In chemistry and biology, Steroids are a type of lipid, characterized by a carbon skeleton with four fused rings. ...


Trauma

Physical trauma, especially fractures of the temporal bone, 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. In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... A fracture is the separation of a body into two, or more, pieces under the action of stress. ... The temporal bones (os temporales) are situated at the sides and base of the skull. ...


Transverse fractures in the horizontal plane present the highest likelihood of facial paralysis (40-50%). Patients may also present with hemotympanum (blood behind the tympanic membrane), sensory deafness, and vertigo – the latter two symptoms due to damage to vestibulocochlear nerve (cranial nerve VIII) and the inner ear. Longitudinal fracture in the vertical plane present a lower likelihood of paralysis (20%). Patients may present with hematorrhea (blood coming out of the external auditory meatus), tympanic membrane tear, fracture of external auditory canal, and conductive hearing loss. The word deaf can have very different meanings depending on the background of the person speaking or the context in which the word is used. ... Dizziness (Latin: Vertigo) is the sensation of instability. ... The vestibulocochlear nerve is the eighth of twelve cranial nerves and also known as the auditory nerve. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Anatomy of the human ear. ... The tympanum or tympanic membrane, colloquially known as eardrum, is a thin membrane that separates the outer ear from the middle ear. ... Anatomy of the human ear. ... Conductive hearing loss is a failure in the efficient conduction of sound waves through the outer ear, typanic membrane (eardrum) or middle ears (ossicles). ...


Traumatic injuries can be assessed by computed tomography (CT) and nerve conduction studies (ENoG). In patients with mild injury, management is the same as with Bell's palsy – protect the eyes 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 nerve, in such cases a surgical treatment may be attempted. In other cases the facial paralysis can occur longtime after the trauma due to oedema and inflammation, in those cases steroids can be a good help. This article does not cite its references or sources. ... The human eye. ...


Tumours

A tumour compressing the facial nerve anywhere along its complex pathway can result in facial paralysis. Common culprits are facial neuromas, congenital cholesteatomas, hemangiomas, acoustic neuromas, parotid gland neoplasms, or metastases of other tumours. Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ... Cholesteatomas are benign tumors in cases where a perforation of the eardrum (tympanic membrane) does not heal without surgery, but instead grows through the hole into the middle ear and, if infection develops, results in a cyst-like tumor. ... Hemangioma is a benign tumor, usually in the shape of a ball, but sometimes a flatter mat, formed by a collection of excess blood vessels in an area. ... Acoustic neuroma (or Vestibular Schwannoma) is a benign tumor of the myelin forming cells called Schwann cells of the 8th cranial nerve, known as the acoustic nerve, (or more properly the vestibulocochlear nerve) just after it has left the brainstem, in the pontine angle; also at the point where the... The parotid gland is the largest of the salivary glands. ... Neoplasia (literally: new growth) is sudden and abnormal growth in a tissue or organ. ... Metastasis (Greek: change of the state) is the spread of cancer from its primary site to other places in the body. ...


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 treated as a cholesteatoma until proven otherwise; hence, there must be immediate surgical exploration. A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...


Computed tomography (CT) or magnetic resonance (MR) imaging should be used to identify the location of the tumour, and it should be managed accordingly.


Herpes zoster oticus

Herpes zoster oticus is essentially a herpes zoster infection that affects cranial nerves VII (facial nerve) and VIII (vestibulocochlear nerve). Patients present with facial paralysis, ear pain, vesicles, sensorineural hearing loss, and vertigo. Management includes antivirals and oral steroids. ... Herpes zoster, colloquially known as shingles, is the reactivation of varicella zoster virus, leading to a crop of painful blisters over the area of a dermatome. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... The facial nerve is seventh of twelve paired cranial nerves. ... The vestibulocochlear nerve is the eighth of twelve cranial nerves and also known as the auditory nerve. ... In cell biology, a vesicle is a relatively small and enclosed compartment, separated from the cytosol by at least one lipid bilayer. ... Sensorineural hearing loss is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve (Cranial nerve VIII), the inner ear, or central processing centers of the brain. ... Dizziness (Latin: Vertigo) is the sensation of instability. ... Antiviral drugs are a class of medication used specifically for treating viral infections. ... Steroid skeleton of lanosterol. ...


Acute and chronic Otitis media

Otitis media 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. Antibiotics are used to control the otitis media, and other options include a wide myringotomy (an incision in the tympanic membrane) or decompression if the patient does not improve Otitis media is an inflammation of the middle ear segment of the ear. ... Staphylococcus aureus - Antibiotics test plate. ... Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum, so as to relieve pressure caused by the excessive buildup of fluid, or to drain pus. ... The tympanum or tympanic membrane, colloquially known as eardrum, is a thin membrane that separates the outer ear from the middle ear. ...


Chronic otitis media usually presents in an ear with chronic discharge (otorrhea), or hearing loss, with or without ear pain (otalgia). Once suspected, there should be immediate surgical exploration to determine if a cholesteatoma has formed and must be removed. Otalgia is ear pain or an earache. ...


References

  • Acute facial nerve paralysis - Powerpoint slides from a lecture presented to second year medical school students at the University of Western Ontario by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
  • Acute facial nerve paralysis - Notes from a lecture presented to second year medical school students at the University of Western Ontario by Dr. Lorne Parnes on 19 November 2004. These notes are licensed under the FDL.
Sensory system - Auditory system - edit
Outer ear: Pinna | Ear canal 

Middle ear: Eardrum | Ossicles (MalleusIncus & Stapes) | Stapedius | Tensor tympani | Eustachian tube GFDL redirects here. ... GFDL redirects here. ... This article or section may be confusing for some readers, and should be edited to be clearer or more simplified. ... The auditory system is the sensory system for the sense of hearing. ... The outer ear is the external portion of the ear and includes the eardrum. ... Juzzah is a loser Boom, Headshot Bergamin and Gerald died The pinna (Latin for feather) is the visible part of the ear that resides outside of the head. ... Anatomy of the human ear. ... The middle ear is the portion of the ear internal to the eardrum, and external to the oval window of the cochlea. ... The tympanic membrane, colloquially known as the eardrum, is a thin membrane that separates the external ear from the middle ear. ... The ossicles (also called auditory ossicles) are the three smallest bones in the human body. ... The malleus is hammer-shaped small bone or ossicle of the middle ear which connects with the incus and is attached to the inner surface of the eardrum. ... This article refers to a bone in the mammalian ear. ... The stapes or stirrup is the stirrup-shaped small bone or ossicle in the middle ear which attaches the incus to the fenestra ovalis, the oval window which is adjacent to the vestibule of the inner ear. ... The stapedius is the smallest striated muscle in the human body. ... The tensor tympani muscle arises from the auditory tube and inserts onto the handle of the malleus, damping down vibration in the ossicles and so reducing the amplitude of sounds. ... Anatomy of the human ear. ...


Inner ear: Cochlea (Scala vestibuliScala media & Scala tympani) | Oval window | Helicotrema | Round window | Basilar membrane | Reissner's membrane | Organ of Corti | Hair cells | Stereocilia The inner ear comprises both: the organ of hearing (the cochlea) and the labyrinth or vestibular apparatus, the organ of balance located in the inner ear that consists of three semicircular canals and the vestibule. ... Cross section of the cochlea. ... Scala vestibuli is a perilymph filled cavity inside the cochlea of the inner ear. ... Scala media is a endolymph filled cavity inside the cochlea, located in between the scala tympani and the scala vestibuli, separated by the basilar membrane and Reissners membrane(the vestibular membrane) respectively. ... Scala tympani is the name of one of the perilymph filled cavities in the cochlear labyrinth. ... The helicotrema is the part of the cochlear labyrinth where the scala tympani and the scala vestibuli meet. ... The round window is one of two membranes that separates the inner ear from the middle ear. ... Cross section of the cochlea. ... Reissners membrane is a membrane inside the cochlea of the inner ear, it separates scala media from scala vestbuli and together with the basilar membrane it creates a compartment in the cochlea filled with perilymph, which is important for the function of the organ of Corti inside the scala... The organ of Corti is the organ in the inner ear of mammals that contains auditory sensory cells, or hair cells. // Structure and function It has highly specialized structures that respond to fluid-borne vibrations in the cochlea with a shearing vector in the hairs of some cochlear hair cells. ... Hair cells are the sensory cells of both the auditory system and the vestibular system in all vertebrates. ... Stereocilia are mechanosensing organelles of hair cells, which respond to fluid motion or fluid pressure changes in numerous types of animals for various functions, primarily hearing. ...


Brain: Cochlear nerve VIII → Cochlear nuclei → Superior olivary nuclei → Lateral  lemniscus  → Inferior colliculi → Medial geniculate nuclei → Primary auditory cortex In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ... The Cochlear nerve (n. ... The vestibulocochlear nerve is the eighth of twelve cranial nerves and also known as the auditory nerve. ... The cochlear nuclei consist of: (a) the lateral cochlear nucleus, corresponding to the tuberculum acusticum on the dorso-lateral surface of the inferior peduncle; and (b) the ventral or accessory cochlear nucleus, placed between the two divisions of the nerve, on the ventral aspect of the inferior peduncle. ... // Anatomy The superior olivary nucleus (or superior olive) is a small mass of gray substance situated on the dorsal surface of the lateral part of the trapezoid body. ... The lateral lemniscus is a tract of axons in the brainstem that carries information about sound to the inferior colliculus of the midbrain. ... The paired inferior colliculi together with the superior colliculi form the eminences of the corpora quadrigemina. ... The medial geniculate nucleus is a nucleus of the thalamus that acts as a relay for auditory information. ... The primary auditory cortex is the region of the brain that is responsible for processing of auditory (sound) information. ...


  Results from FactBites:
 
Core Curriculum Syllabus: Facial Paralysis (1779 words)
Anatomy of the facial nerve and fallopian canal
Interpretation: Absence of the reflex is due to a lesion proximal to stapedius nerve (vertical segment of facial nerve).
Otalgia, facial weakness and a vesicular eruption on the concha or external canal (sensory distribution of 7th cranial nerve) characterize herpes zoster oticus (Ramsay-Hunt Syndrome).
  More results at FactBites »

 
 

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