Management and classification Dr.Ishara Maduka Facial nerve palsy Management and classification Dr.Ishara Maduka

Objectives What is facial nerve Structures supplied by facial nerve Causes of facial nerve palsy Clinical features of facial nerve palsy Bells Palsy

What is facial nerve Facial nerve is the VIIth cranial nerve. It’s a mixed cranial nerve. It means it has both sensory and the motor components. It originates at the level of pons in brain stem and exit the cranial cavity through stylomastoid foramen and enter into parotid gland.

Structures supplied by the facial nerve Tearing --  Lacrimal Gland Taste -- Anterior 2/3 of the Tongue Saliva Production -- Sublingual Gland, Submandibular Gland,  Nasal and Palatine Gland Muscles of Facial Expression Stapedius Muscle -- A muscle which helps to protect the ear from loud noises. Contains a few somatic afferent fibers.

Structures supplied by the facial nerve

Structures supplied by the facial nerve Frontalis - Innervates the Forehead muscles Orbicularis Oculi - Eyelid muscles Orbicularis Oris  - Lip muscles

Causes of facial nerve palsy Supranuclear Infranuclear Strokes Bells palsy (Commonest) Trauma Herpes Zoster Otitis media Parotid gland tumour

Clinical features of facial nerve palsy Facial asymmetry Eyebrow droop Loss of forehead & nasolabial folds Drooping of corner of mouth Uncontrolled tearing Inability to close eye Lips not held tightly together: Difficulty keeping food in mouth Facial muscle atrophy (Late)

Clinical features of facial nerve palsy What’s the difference between supranuclear and infranuclear facial nerve palsy. In Supranuclear palsy – paralysis is limited to the lower half of the face. In infranuclear palsy – paralysis affects the whole face

Reason? Homework? The upper half of the face receives nerve supply from both sides.

Right sided facial nerve palsy

Treatment of Facial nerve palsy Depend on the cause. Treatment of the cause will relieve symptoms. E.g. – Otitis media – Antibiotics, drainage Tumour - Excision

Bell’s Palsy Bell's palsy is thought to be due to swelling (inflammation) of this nerve in the area where it travels through the bones of the skull. The cause is often not clear. (Idiopathic) A type of herpes infection called herpes zoster might be involved.

Treatment of Bell’s palsy Corticosteroids Anti- viral medications: E.g. Acyclovir Protect eye from exposure Facial exercise – Facial retraining

Assignment Find out about the facial retraining techniques.