FACIAL NERVE PARALYSIS

Facial Nerve Paralysis OF FACIAL NERVE PARALYSIS

Causes of facial nerve paralysis
? Supranuclear and nuclear
Cerebral vascular lesions
Poliomyelitis
Cerebral tumours
? Infranuclear
Bell’s palsy
Trauma (birth injury, fractured temporal bone, surgical)
Tumours (acoustic neurofibroma , parotid tumours , malignant disease of the middle ear)
Suppuration (acute or chronic otitis media)
Ramsay Hunt syndrome
Multiple sclerosis
Guillain–Barré syndrome
Sarcoidosis

Bell’s palsy (idiopathic facial paralysis)
Bell’s palsy is a lower motor neurone facial palsy of unknown cause, but possibly viral. It is part of the group of idiopathic cranial mono-neuropathies. Bell’s palsy may be complete or incomplete; the more severe the palsy, the worse the prognosis for recovery.
In practice, full recovery may be expected in 85% of cases.
Treatment of Bell’s palsy should not be delayed.
1- Prednisolone given orally is the treatment of choice, but only if started in the first 24 h. In an adult, start with 80 mg daily and reduce the dose steadily to zero over a period of 2 weeks.
2- Surgical decompression of the facial nerve is a matter of controversy: some authorities decompress at an early stage: most do not advise decompression.
3- Tarsorrhaphy may be needed to protect the cornea of the unblinking eye.
Do not make a diagnosis of Bell’s palsy until you have excluded other causes. If recovery does not take place in 6 months, reconsider the diagnosis.