Skip to Main Content

++

Facial nerve dysfunction can dramatically affect a patient's quality of life. The human face is a focal point for expression and interpersonal communication, whereas facial motor movement contributes to eye protection, speech articulation, chewing and swallowing, and emotional expression. Thus, the patient with a facial palsy suffers not only the functional consequences of impaired facial motion but also the psychological impact of a skewed facial appearance.

++

Essentials of Diagnosis

++

Bell's Palsy

++

  • Acute onset, with unilateral paresis or paralysis of the face in a pattern consistent with peripheral nerve dysfunction (all branches affected).
  • Rapid onset and evolution (<48 hours).
  • Facial palsy may be associated with acute neuropathies affecting other cranial nerves (particularly, cranial nerves V–X).

++

Herpes Zoster Oticus (Ramsay Hunt syndrome)

++

  • Acute peripheral facial palsy associated with otalgia and varicella-like cutaneous lesions that involve the external ear, skin of the ear canal, or the soft palate.
  • Involvement often extends to cranial nerves V, IX, and X, and cervical branches that have anastomotic communications with the facial nerve.
  • Differentiated from Bell's palsy by characteristic cutaneous ulcers and a higher incidence of hearing loss or balance dysfunction.

++

General Considerations

++

There are a variety of disorders that may be associated with unilateral facial palsies (Table 70–1). Bilateral facial palsy is much less frequent and occurs in less than 2% of patients presenting with an acute facial palsy (Table 70–2). Bilateral involvement typically reflects a systemic disorder with multiple manifestations. Because of their overlapping clinical presentation and treatment paradigms, Bell's palsy and herpes zoster oticus (also known as Ramsay Hunt syndrome) will be considered together.

++
Table Graphic Jump Location
Table 70–1. Differential Diagnoses of Facial Paralysis.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.