Facial paralysis: Difference between revisions

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==Clinical Features==
==Clinical Features==
[[File:Bell's palsy.png|thumb|Right-sided peripheral facial nerve palsy with inability to wrinkle the forehead and nose, unequal lid fissures, and inability to lift the corner of the mouth.]]
[[File:Bell's palsy.png|thumb|Right-sided peripheral facial nerve palsy with inability to wrinkle the forehead and nose, unequal lid fissures, and inability to lift the corner of the mouth.]]
[[File:Bellspalsy.jpg|thumb|A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side; notice how the forehead is NOT spared).]]
===Central Process===
===Central Process===
* Forehead "sparing" or normal muscle tone of the forehead
* Forehead "sparing" or normal muscle tone of the forehead

Revision as of 16:24, 3 February 2020

Background

Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for stroke but not Bell's palsy (or other peripheral facial nerve injury).
  • Key to distinguish between central and peripheral facial nerve palsy

Causes

Clinical Features

Right-sided peripheral facial nerve palsy with inability to wrinkle the forehead and nose, unequal lid fissures, and inability to lift the corner of the mouth.
A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side; notice how the forehead is NOT spared).

Central Process

  • Forehead "sparing" or normal muscle tone of the forehead

Peripheral Process

  • Weakness of forehead muscles

Central and Peripheral

  • Unable to close eye
  • Loss of nasolabial fold
  • Asymmetric smile

Differential Diagnosis

Facial paralysis

Evaluation

Central Process

Peripheral Process

  • No labs or imaging routinely necessary
  • Consider lyme serologies if endemic area

Management

Central Process

  • Treat underlying pathology

Peripheral Process

  • Prednisone (unless diagnosed Lyme disease)
  • Empiric doxycycline if high suspicion for Lyme disease
  • Consider valacyclovir for severe presentation if Lyme is negative
  • Artificial tears
  • Consider neurology follow-up

Disposition

See Also

External Links

References