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Facial nerve paralysis ppt

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Facial nerve , anatomy , pathology , diagnosis , management .

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Facial nerve paralysis ppt

  1. 1. Facial Nerve<br />By<br />Dr. Ibrahim Habib<br />ENT Consultant (MD)<br />
  2. 2. ( وجعل لكم السمع والأبصار والأفئدة قليلا ما تشكرون ) ( السجدة : 9 )<br />(هذا خلق الله فأروني ماذا خلق الذين من دونه ) ( لقمان : 10 ) <br />( فأقم وجهك للدين القيم من قبل أن يأتي يوم لا مرد له من الله ) ( الروم : 43 )<br />
  3. 3. Facial Nerve Anatomy<br />Mixed nerve<br />Sensory: from Nucleus Solitarius<br />Motor : Facial nucleus (at the level of Pons)<br />Parasympathetic: superior salivary nucleus<br />
  4. 4. Segments of Facial Nerve<br />
  5. 5. Course of Facial Nerve<br />
  6. 6.
  7. 7.
  8. 8.
  9. 9. Branches of Facial Nerve<br />
  10. 10. Facial N. Branches<br />
  11. 11. Facial N. Branches( cont. )<br />
  12. 12. Pathophysiology of nerve injury <br />Neuropraxia : Blocks flow of axoplasm from stoma to distal axon.<br />Axonotemesis : Wallerian degeneration with intactendoneural tubules.<br />Neurotemesis : Wallerian degeneration with loss of endoneural tubules .<br />Transection : Complete division of the nerve .<br />
  13. 13. Facial nerve paralysis: Signs<br />Facial asymmetry<br />Eyebrow droop<br />Loss of forehead & nasolabial folds<br />Drooping of corner of mouth<br />Uncontrolled tearing<br />Inability to close eye<br />Lips cannot be held tightly together: difficulty keeping food in mouth<br />Facial muscle atrophy ( late (  <br />
  14. 14. Facial nerve palsy<br />
  15. 15. Clinical Testing of Facial Nerve Functions<br />Observe patient Face<br /> during rest & movement for :<br />Asymmetry<br />Hemi facial spasm<br />Facial tics<br />blinking<br />
  16. 16. Clinical Testing of Facial Nerve Functions<br />Blink test: Delay in blinking on one side<br />Testing facial movement<br />Temporal branch: <br /> To wrinkle forehead, <br /> To elevate eye brow<br />Zygomatic branch: to screw up the eye<br />Buccal branch: to wrinkle the nose<br />Mandibular branch: to show the teeth, to blow out the cheeks<br />Crvical branch: by grimacing<br />
  17. 17. House-Brackmann grading system of facial function<br />
  18. 18. House-Brackmann grading system of facial function (cont.)<br />
  19. 19. Features associated with facial palsy <br />Synkinesis: movement of group of muscles that don’t usually contract together.<br />Hemifacial spasm: an intermittent spasm of some or all of the facial muscles<br />Facial myokymia: multiple facial movement.<br />Blepharospasm: involuntary spasmodic eye closure<br />Crocodile tears: lacrimation with eating due to regenerating motor nerve fibers connect the greater petrosal nerve.<br />
  20. 20. Topognostic testing<br />Help to determine the site of facial n. injury<br />
  21. 21. Supranuclear lesion :<br />Lower face palsy associated with neurological deficit<br />Nuclear lesion:<br />Motor function affected only<br />
  22. 22. C P A , labyrinthine segment , geniculate ganglion lesions :<br />Lacrimation , stapedeal reflex , taste , salivation impaired<br />Lesion between geniculate g. and n. to stapedius :<br />Stapedeal reflex , taste , salivation lost .<br />
  23. 23. Lesion between stapedius and chorda tympani n. :<br />Taste impaired .<br />Lesion bellow chorda tympani n. :<br />Pure motor deficit .<br />
  24. 24. Topognostic testing of Facial palsy<br />
  25. 25. Topognostic testing of Facial palsy (cont.)<br />
  26. 26. Topognostic testing of Facial palsy (cont.)<br />
  27. 27. Causes of facial nerve palsy<br />Congenital <br />Birth trauma. <br />Inherited disorder .<br />Mytonic dystrophy<br />Albers –Schoenberg disease<br /> Osteoporosis of bony canals for cranial n. III, VIII & VII cranial n. affected.<br />Developmental abnormalities .<br />Moebius syndrome<br />Occulo-auriculo-vertebral syndrome<br />
  28. 28. Causes of facial nerve palsy(cont.)<br />Inflammatory :<br /> Bell’s palsy ( an acute peripheral self- limiting (55% ) non progressive facial paralysis due to viral inflammatory process <br />Ramzy Hunt syndrome (7%) (herpes zoster virus causes facial palsy and vesicles often visible in ext. ear canal & on tympanic membrane.<br />Lyme disease ( tick - born spirochaete causes facial paralysis in children)<br />
  29. 29. Causes of facial nerve palsy(cont.)<br />AIDS ( HIV causes facial paralysis as a result of :<br /> -herpes zoster Atticus<br /> -progressive multifocal leucoencephalopath<br /> - Neoplasm<br />Suppurative otitis media( 4%)<br />- facial paralysis may complicate acute or chronic suppurative otitis media or malignant otitis externa. <br />
  30. 30. Causes of facial nerve palsy(cont.)<br /><ul><li>In ASOM.: infection spreads through congenital dehiscence.
  31. 31. In chronic SOM: compression of facial n. by cholesteatoma or granulation tissue
  32. 32. In malignant otitis externa Pseudomonas causes infection of ear canal in immunocompromised patient forming granulation tissue in ear canal , spread of infection causes facial paralysis and other cranial nerve affection .</li></li></ul><li>Causes of facial nerve palsy(cont.)<br />Neoplasm ( 6% )<br />Benign facial n. tumours : <br />Schwanoma<br />Meningioma , angiomas , haemangiomas .<br />Malignant facial n, tumours :<br />Acoustic neuromas .<br />
  33. 33. Causes of facial nerve palsy(cont.)<br />Traumatic facial nerve paralysis ( 19 %)<br />Iatrogenic injury :<br />Chronic ear surgery .<br />Parotid tumor resection .<br />Facial nerve tumor resection .<br />Resection of acoustic tumor .<br />Temporal bone fracture .<br />Facial wounds .<br />
  34. 34. cholesteatoma<br />
  35. 35. Acinic cell tumour<br />
  36. 36. parotidecomy<br />
  37. 37.
  38. 38. C T temporal bone fracture<br />
  39. 39. Temporal bone fracture<br />
  40. 40. Acoustic neuroma<br />
  41. 41. Causes of facial nerve palsy(cont.)<br />Other causes :<br />Multiple sclerosis .<br />Cerebrovascular accident .<br />Myasthenia gravis .<br />Sarcoidosis .<br />
  42. 42. Treatment of facial palsy<br />Eye protection <br />Specific treatment :<br />Bell’s palsy ; steroids and decompression .<br />Ramsay Huntsyndrom ; acyclovir .<br />Trauma ; exploration and repair .<br />Tumour ; may need facial nerve sacrifice .<br />Infection ; in chronic otitis media need mastiod exploration.<br />
  43. 43. ventilation tube insertion<br />
  44. 44. mastoidectomy<br />
  45. 45. Thank you<br />Dr. Ibrahim HabibBarakat<br /> ENT consultant (MD)<br />E-mail: salamatuall@yahoo.com<br />www.facebook.com/Dr.Ibrahim.Barakat<br />

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