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Facial Nerve

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Facial Nerve Bastaninejad Shahin, MD, Otolaryngologist VIIth nerve Anatomy 15-17 CPA 8-10 IAC 4mm 11mm 13mm Porus Fundus G.G. Selected Clinical Scenarios ... – PowerPoint PPT presentation

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Title: Facial Nerve


1
Facial Nerve
  • Bastaninejad Shahin, MD, Otolaryngologist

2
VIIth nerve Anatomy
3
4mm
11mm
8-10 IAC
15-17 CPA
13mm
Porus Fundus
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5
G.G.
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Selected Clinical Scenarios
10
Bells Palsy
  • Spontaneous idiopathic facial paralysis
  • paralysis or paresis of all muscle groups of one
    side of the face
  • sudden onset
  • absence of signs of CNS disease
  • absence of signs of ear or cerebellopontine angle
    disease

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  • Incidence 20-30/100000, its greater in more than
    65yrs
  • M/F ratio is equal, but in less than 20yrs its
    more common in F but in more than 40yrs, its
    more common in M.
  • 30 have incomplete paralysis
  • 70 have complete paralysis

13
Bells Etiology
  • Microcirculatory failure of vasa nervorum
  • Viral infection ? most accepted concept
  • Ischemic neuropathy
  • A.I. reaction

HSV Reactivation
14
  • Other caranial nerve involvment in Bells palsy
    (in more than 50 of the pts)

5,7,9,10 C2
15
  • Site of involvement proximal Labyrinthine and
    meatal portion
  • Prognosis is excellent 80-90 complete recovery
    (95-100 in partial paralysis)
  • Poor outcome measures
  • Hyperacusis (brain stem reactivation)
  • Decreased tearing
  • Age more than 60
  • DM and HTN
  • Severe aural and facial radicular pain

16
Bells Palsy (cont)
  • Bells in Children
  • Female preponderance
  • 97 full recovery
  • Impact of corticosteroid is uncertain!
  • Familial Bells?8
  • Recurrent?9.3
  • More common in females, and DM sufferers
  • No prognostic difference with primary Bells

17
Bells in pregnancy
  • More frequent in pregnant women (3.3)
  • Most common in third trimester or immediate
    postpartum
  • Pre-eclampsia is a RF
  • Treatment is with prednisolone

18
  • Management
  • Corticosteroids (mainstay) 1mg/kg/day in seven
    days, then taper it down
  • Antiviral agents
  • Surgery within 2wks if ENOG showed more than 90
    axonal degeneration (Gantz et al.)

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Ramsay Hunt Syndrome (RHS)
  • Skin vesicles (aural, facial ,...) faicial
    nerve paralysis
  • Relates to VZV ( while Bells was ? HSV )
  • Its 2nd most common cause of the facial
    paralysis
  • Complete recovery
  • In complete paralysis? 10!
  • In incomplete paralysis? 66

?Poor outcome
21
  • Treatment is with Corticosteroid and Acyclovir
  • The main benefit of the corticostroid is
    reduction of postherpetic neuralgia, vertigo and
    acute pain (? its usefulness on recovery of the
    nerve is controvercial)

22
Congenital facial paralysis
  • Birth trauma ? 78
  • Syndromic (Mobius syn., CHARGE,...)
  • Surgical exploration and decompression of the
    nerve is rarely
  • useful
  • Main option is
  • muscle transfer.

6th and Mastoid segment of the 7th nerve
23
Bilateral Facial Paralysis
  • Guillain barre syndrome (9, 10, 7)
  • Bells palsy ? 0.3 to 2 of pts
  • Idiopathic cranial neuropathies
  • Brain stem encephalitis
  • BIH
  • Syphilis
  • Leukemia
  • Sarcoidosis, Lyme disease ...

24
Traumatic Facial Paralysis
  • Most susceptible region distal Labyrinthine and
    Geniculate ganglion
  • Surgical timing depends on the onset after injury
    (late, immediate)

25
Blunt head truma (sharp nerve cut ? repair in 3
days)
  • Surgical time planing
  • Immediate paralysis 3 wks after onset
  • Delayed paralysis Expectant management and
    corticosteroids will be Okay!, but surgery
    indicates when you see gross disruption of
    fallopian canal in the CT-scan.
  • Fisch advocates surgical intervention on the
    basis of ENOG, rather than time of onset of the
    paralysis (...gt90 degeneration within 6 days of
    onset)

26
Otitis Media
  • AOM, COM, Cholesteatoma
  • Most susceptible segment is Tympanic part
  • AOM ?IV Abx Myringotomy
  • Cholesteatoma ? Removal of the choles. nerve
    decompression without opening the perineurium
  • COM ? decide regarding to the degree of
    inflammation

27
Thank You!
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