في هذه الفقره التي نحرص وبشكل دوري على القاء الضوء على موضوعات تهم المختصين في مجال التاهيل الطبي وموضوع هذه الحلقه شلل الوجه

 FACIAL NERVE (VII) PARALYSIS

• 2 roots
  • Motor from facial nucleus
  • Nervus intermedius
    • Sensory afferents: skin & taste (to nucleus tractus solitarius)
    • Preganglionic parasympathetics (from superior salivatory nucleus)
• Major branches
  • Large petrosal: Lacrimation & salivation
  • Nerve to stapedius
  • Chorda tympani: Taste
  • Motor branches

Bell's Palsy

• Epidemiology
  • Lifetime prevalence: 6.4 per 1,000
  • Incidence: Increased with age
    • Overall: 0.5 per year per 1,000
    • Age 20: 0.1 per year per 1,000
    • Age 80: 0.6 per year per 1,000
  • Male = Female
  • Recurrence: 7%
  • Side: Right in 63%
• Clinical Features
  • Onset
    • 3 to 72 hours
    • Pain (50%): Near mastoid process
    • Excess tearing (33%)
    • Other: Hyperacusis; Dysgeusia
  • Signs
    • Facial weakness: Upper & lower; Unilateral
    • Stapedius dysfunction (33%)
    • Lacrimation: mildly affected in some patients
    • Taste: No clinically significant changes in most patients
  • Prognosis better
    • Incomplete paralysis
    • Slow progression
    • Younger age
    • Normal salivary flow
    • Electrodiagnostic tests normal
      • Nerve excitability
      • Electrogustometry
• Treatment of Bell's palsy:
  • Corticosteroids within one week of onset
  • Prednisone 80 mg qd x 5 days; then taper over 1 week

• Unilateral VII weakness
  • Idiopathic: Bell's palsy
  • Sarcoid & other granulomatous disorders
  • Infection
    • Leprosy: Especially with paralysis of upper face
    • Otitis media
    • Lyme disease
    • Herpes Zoster (Ramsay Hunt syndrome)
  • Neoplasm & Masses
  • Trauma
  • Cardiofacial syndrome (lower lip palsy)
    
  • Familial
  • CNS lesions
  
  
• Bilateral VII weakness
  • Melkersson syndrome
  • Möbius syndrome
  • Guillain Barré
  • Motor neuron disorders
  • Myasthenia gravis
  • Myopathies
  • Leprosy
  • An-a-lipoproteinemia (Tangier)
  
  
• Central VII lesions
  • Pyramidal: Lower face paralysis with voluntary motion
  • Emotional²: Face paralysis with emotion
    • Anatomy: Dorsolateral pons lesion
    • Disorders
      • Superior cerebellar artery infarction: Unilateral; With Deafness, Horner's, or ê Sweating
      • Extrapyramidal disorders: Bilateral; Parkinsonism

Melkersson-Rosenthal syndrome
  l Chromosome 9p11; Dominant

• Clinical
  • Onset
    • 5 to 70 years
    • Incomplete penetrance
  • Recurrent facial palsy
    • Unilateral or Bilateral
    • May include loss of taste
  • Edema: Facial, Lip & Eyelid; Non-pitting
  • Onset: < 16 years
  • Lingua plicata (Scrotal tongue)
• Laboratory
  • Eyelid pathology: Granulomatous lymphangitis

• Facial paresis: Congenital
• Often with ophthalmoplegia

• Associated with attempted abortion using misoprostol: Odds ratio = 38

  l MBS1: Chromosome 13q12.2-q13; Dominant , or

• Clinical
  • Congenital facial diplegia; ± Asymmetric
  • Ophthalmoplegia, esp VI nerve
  • Mental retardation
  • ± Peripheral neuropathy
  • Skeletal: Arthrogryposis; Orofacial malformations; Rib defects
  • Muscle aplasia
  • Respiratory failure: Central; Associated with tegmental brainstem calcification
  • Hypogonadotropic hypogonadism
• Pathology: Aplasia or hypoplasia of cranial nerves & nuclei

  l MBS2: Chromosome 3q; Dominant

• Facial weakness: Asymmetric; Unequal involvement of the 3 branches of the facial nerve

  l MBS3: Chromosome 10q; Dominant¹

• Variable penetrance
• Facial weakness: Unilateral or Bilateral
• Hearing loss: Congenital deafness, or Progressive hearing loss with age

• Trauma
  • Petrous bone fracture
  • Surgery: Middle ear; Mastoidectomy; Parotid gland
• Tumors & Masses
  • Neuroma/Neurinoma
  • Meningioma
  • Cholesteatoma
  • Parotid gland
  • Metastasis
  • Carcinomatous meningitis
  • Paget: Osteopetrosis