FACIAL PALSY

Prepared & Presented by

Dr. Abdiladhif Mohamed Ali,
MBChB (Grodno Medical University. Belarus),
Msc Neurology (Grodno- Belarus).
 INTRODUCTIO
• N
Facial function plays an integral part in
our everyday lives
– Smile; nonverbal communication, etc.
• Facial paralysis is devastating on many
levels
– Functional
– Cosmetic
• Fortunately, a plethora of techniques are
available to treat the paralyzed face.
FACIAL NERVE
 FACIAL NERVE
 7th Cranial nerve
 Nerve of the 2nd branchial
arch
 Has two roots. A large
motor and a smaller mixed
sensory and
parasympathetic (nervus
intermedius)
The facial nerve is
responsible for:

I. Contraction of the
muscles of the face

II. Production of tears

from a
gland (Lacrimal
III. Conveying
gland) the sense of
taste from the front
part of the tongue (via
the Chorda tympani
nerve)
IV. The sense of touch
at auricular conchae
 FACIAL
PARALYSIS
 Commonly Unilateral

 Nuclear- from
destruction of the
nucleus

 Central or cerebral or
Supranuclear

 Peripheral- from a lesion

of the nerve
 ETIOLOGIC CLASSIFICATON OF
FACIAL PALSY
Various classification have been suggested in this
respect.
Based on:
 Course of the nerve

 Various etiologic causes

 Degree of dysfunction observed

 INTRACRANIAL (CENTRAL) CAUSES

 Vascular abnormalities
 CNS degenerative diseases
 Tumours of the intracranial cavity
 Trauma to the brain
 Congenital abnormalities and
agenesis
 INTRATEMPORAL CAUSES

 Bacterial and Viral infection

 Cholesteatoma
 Trauma- blunt temporal bone trauma,
longitudinal and horizontal fractures of the
temporal bone and gunshot wounds.
 Tumours invading the middle ear, mastoid and
facial nerve
 Iatrogenic causes
 EXTRACRANIAL
CAUSES
 Malignant tumours of the parotid gland
 Trauma
 Iatrogenic causes
 Primary tumours of the facial nerve
 Malignant tumours of the ascending ramus of the
mandible, pterygoid region and skin.
 RAINER SCHMELZEISEN
CLASSIFICATION
 CONGENITAL  NEOPLASTIC
 Moebius Syndrome  Facial nerve tumours
 Myotonic dystrophy  Glomus tumours
 Melkersson Rosenthal syndrome  Meningiomas, acoustic
 Congenital Cholesteatoma neuroma
 Birth injuries  Parotid tumours
 Osteopetrosis  Temporal
bone/external auditory
 NEUROLOGIC meatus tumours
 Myasthenia Gravis
 Multiple Sclerosis  INFECTIONS
 Guillain Barre syndrome  Otitis media,
mastoiditis
 Bacterial causes
 HOUSE-BRACKMAN(1985)
• CLASSIFICATION
Grade I-normal function without weakness.
• Grade II-mild dysfunction with sligth facial asymmetry
with a minor degree of synkinesis.
• Grade III-moderate dysfunctions-obvious, but not
disfiguring, asymmetry with contracture and/or
hemifacial spasm, but residual forehead motion and
incomplete eye closure.
• Grade IV-moderately severe dysfunction- obvious,
disfiguring asymmetry with lack of forehead motion and
incomplete eye closure.
• Grade V-severe dysfunction-asymmetry at rest and
only slight facial movement.
• Grade VI-total paralysis-complete absence of tone
or motion.
 Infectious/Idiopathic
Melkerson-Rosenthal syndrome
Congenital Ramsay-Hunt
MÖbius syndrome Otitis media/mastoiditis/meningitis
Myotonic Lyme Disease
dystrophy Necrotizing Otitis externa
HIV, TB, EBV, syphillis
Tetanus
Neurologic
Guillian-Barre Facial Systemic
Myasthena Gravis Paralysis Sarcoidosis
Stroke Amyloidosis
Multiple sclerosis
Hyperostosis

Toxins/
Tumor
Trauma Head
Parotid
trauma
Acoustic neuroma
Temporal bone Endocrine Glioma
trauma DM Meningioma
Birth trauma Pregnancy Facial neuroma
Hyperthyroidism
 BELL’S
PALSY
• It is defined as an
idiopathic paresis or paralysis
of the facial nerve of sudden
onset.
• The name was ascribed to
SIR CHARLES BELL, who in
1821 demonstrated the
separation of motor and sensory
innervation of face.
• INCIDENCE-15-40 cases per 1000000 cases

• SEX PREDILECTION- women more affected

than men.3.3 more times common in
pregnancy and in the third trimester.

• AGE- can occur at any age, common in middle

aged people.

• SIDE INVOLVMENT- can be equally seen,

usually unilateral.
CLINICAL FEATURES

• There is sudden onset, usually pt gives h/o

occurrence after awakening early
morning.

• Unilateral involvement of entire side of the

face.

• Abrupt loss of muscular on one side of

face.

• Inability to smile, close the eye or raise

the eyebrow on affected side.
• In an attempt to close eyelid, the
eyeball rolls upward.

• Inability to wrinkle forehead or

elevate upper or lower lip.

• Obliteration of nasolabial fold.

Face appears distorted and mask like

appearance to the facial features.

Speech becomes slurred.

Occasionally there is loss or alternative

of taste.
 Treatment
• Oral antivirals - Acyclovir
• Corticosteroids
• Eye protection
• Follow progression with serial exams
• Physiotherapy
 MEDICATIO
N
• If the patient is seen within 2 to 3 weeks of onset
of symptoms-tab. Prednisolone in doses of
1mg/kg/d for 10 to 14 days has been
recommended with a gradual tapering.
• Vitamins B1, B6, B12 may be administered.
• If pt is seen after 3-4 weeks, then steroid therapy
is of no use.
 SURGICAL TREATMENT
MODALITIES
• Nerve decompression - Internally or externally

• Nerve anastomosis

• Nerve grafting
Partial paralysis always resolves completely within a few
weeks.

Recovery from complete paralysis takes longer

(months) and is complete in only about 60-70% of
cases.

Approximately 15% of patients are left with troublesome

residual palsy and or synkinesis.
 COMPLICATIONS OF FACIAL
PARALYSIS

Facial paralysis severely hinders:

• Normal facial expressions
• Mastication
• Speech production
• Eye protection.
 Psychological Trauma
• The most significant complication is the social
isolation these patients often succumb to.