Facial Paralysis



10.1055/b-0034-97710

Facial Paralysis

Alison K. Snyder-Warwick & Thomas H. H. Tung
A 6-year-old boy presents with inability to smile on left side, present since birth


Description




  • Complete left-sided facial paralysis.



  • Facial asymmetry: Left palpebral fissure widening, left nasolabial fold effacement, right-sided deviation of Cupid′s bow, and inferior malposition of the left oral commissure, which demonstrates no movement with smiling.



  • The child has a fairly balanced brow position and minimal external nasal valve asymmetry.



Work-up



History




  • Onset of symptoms




    • Congenital or acquired.



    • Acute, subacute, or chronic.



  • Duration and rate of progression.



  • Complete or incomplete; unilateral or bilateral.



  • Associated syndromes or syndromic features.



  • Associated symptoms: Headaches, blurred vision, dry eyes, vertigo, hearing loss, otorrhea, oral incompetence, speech difficulties, snoring, nasal obstruction.



  • History of the following: Trauma; infection (Bell palsy, Ramsay Hunt syndrome, Lyme disease, tuberculosis); neuromuscular disease (myasthenia gravis, Charcot-Marie-Tooth disease, Guillain–Barré syndrome); tumors (neurofibromatosis type 2); diabetes; travel history; pregnancy; family history; surgical history (otologic, rhytidectomy, parotidectomy).



Physical examination




  • Perform complete head, neck, and cranial nerve examination.



  • Examine all branches of the facial nerve.




    • Temporal (frontal): Elevation of forehead.



    • Zygomatic: Closure of orbicularis oculi.



    • Buccal: Elevation of cheek and oral commissure.



    • Marginal mandibular: Depression of oral commissure and lower lip.



    • Cervical: Contraction of platysma.



  • Eyes: Evaluate eye closure, vision, corneal defects, ectropion.




    • Schirmer test (see Case 18).



    • Bell’s phenomenon (see Case 18): If absent, greater concern for corneal injury.



  • Evaluate facial movements at rest and in multiple different expressions.




    • Assess midline deviation, measure amount of excursion with movement.



    • Assess brow movement, nasal valve function, and synkinesis (involuntary contraction of additional facial muscles with voluntary facial movement due to aberrant neuroregeneration).



  • Assess overall muscle status (hypertonic, normal, or atrophic), voluntary and involuntary movements (synkinesis, fasciculations).



Pertinent imaging or diagnostic studies




  • Vary by case.



  • Hematologic work up: Complete blood cell count (evaluate for infection, leukemia), Lyme titer.



  • Temporal bone computed tomography.



  • Magnetic resonance imaging: To evaluate brain, facial nerve, or parotid glands.



  • Biopsy: Facial nerve, lip (for salivary tumors), fine needle aspiration of parotid mass.



  • Electrodiagnostic studies: Nerve conduction studies, electromyography (EMG).



  • Electroneurography (ENoG): Compares amplitude of summation potentials of paralyzed side of face with that of normal side.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Facial Paralysis

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