Quiz 17 Facial Nerve Palsy

Front 1

A 75 year-old woman presented with deviation of angle of mouth to right. On left side of face, the naso-labial fold was shallow. Also there was weakness of upper and lower limb on left side. Wrinkling of forehead was present on either sides and closure of eyes possible on both sides.

Back 1

UMN Facial Palsy associated with Hemiplegia.

The lesion at the level of internal capsule on left.

Facial nerve weakness is on the same side

UMN lesion sparing the upper part of face

It gets supra-nuclear fibers from both sides

Lower part gets fibers only from opposite

Front 2

A 65 year-old man presented with deviation of angle of mouth to left. But this was noticed only during smiling; and it disappeared on voluntary movement. When he attempted to show the teeth, both angles of mouth deviated equally to either sides. He had right brachial monoplegia.

Back 2

Unilateral Emotional Facial Palsy.

The lesion is usually in the inferior frontal lobe on right side involving the UMN emotional fibres.

Or occurs in deep seated lesions of thalamus.

Or the thalamic-frontal connections.

Vascular accidents and neoplasms.

Front 3

This 85 year-old man presented with sudden onset weakness of the left upper and lower limbs. The deviation of angle of mouth was surprisingly towards the same side. He had a right sixth nerve palsy. There were no sensory or cerebellar signs. The left plantar was extensor.

Back 3

LMN Facial Palsy in Pons with crossed Hemiplegia

Right sided seventh nerve paralysis

LMN type of facial weakness on right side

Left sided hemiplegia ie on opposite side

This is an upper motor neuron lesion.

Vascular accidents, tuberculoma, tumors

Front 4

This 65 year-old woman presented with numbness on left side of face and deviation of angle of mouth to the right side. She also has recent onset of sensory neural deafness of left ear, headache and vomiting. There was a tendency to fall to left side since three months.

Back 4

Cerebello-pontine angle lesion on left side

Left sided LMN VII nerve palsy

Left sided LMN VIII nerve palsy

Left sided cerebellar signs

Symptoms and signs of increased ICT

Acoustic neuroma, meningioma or shwanoma

Front 5

This 65 year-old man sustained a road traffic accident, and lost consciousness briefly. He noticed deviation of angle of mouth to the left and inability to close the right eye. He also has decreased lacrimation of right eye and reduced taste sensations on the right half of tongue.

Back 5

Facial Nerve Injury in the Facial canal

Due to fracture of petrous temporal bone

All the three nerve branches are involved

Means level is above geniculate ganglion

Can be diagnosed by an X ray of skull

Front 6

A 35 year-old man complained of acute onset of pain in left ear. Examination of left ear and palate showed small blisters containing clear fluid. Angle of mouth was deviated to the right side and Bell’s phenomenon was seen on the left. Hyperacusis and loss of taste of anterior 2/3 of tongue were present.

Back 6

LMN Facial palsy due to Ramsay Hunt Syndrome (Herpes Zoster Infection of Geniculate ganglion)

LMN facial paralysis.

Tear production is affected.

Hyperacusis is often present.

Affection of taste sensation also present.

Front 7

In this 45 year-old woman underwent an emergency surgery of the right ear; following this she developed a facial paralysis involving the whole of right side of face along with hyper-acusis and loss of sensation of taste in anterior two-thirds of tongue. Lacrimation was normal.

Back 7

Injury to the Facial Nerve

in the Middle Ear Cavity during surgery

Lesion is after the superficial petrosal branch

Therefore tear formation is not affected

Before the departure of chordae tympani

Lesion has to be in relation to middle ear

Front 8

In this 45 year-old man, the left corner of mouth is drooped, left side of forehead is un-furrowed, and the eyelids do not close. Upon attempted closure, the left eye is seen to roll upwards. The lower lid is sagged, permitting tears to spill over the cheek. Taste sensations of tongue is normal

Back 8

Bells Palsy Left.

No affection of lacrimation

No affection of hearing

Usually no affection of taste also

LMN Facial Palsy at the Stylomastoid Foramen.

Due to Herpes Simplex lesion at SMF.

Front 9

This 45 year-old woman had a Bell’s palsy on the right side of face from which she was gradually recovering. Since then she noticed that while chewing food each time her eyelids were getting closed automatically. On occasions, when patient was trying to close the eyes the angle of mouth was found to be deviated to the side.

Back 9

Facial Nerve Synkinesis.

It is a facial nerve renervation abnormality.

There is a cross linking of fibres destined to orbicularis oculi and orbicularis auris.

Hence called "jaw winking phenomenon"

Named after "Marcus and Gunn"

Front 10

This 45 year old man has deviation of angle of the mouth to the left side. There was normal lacrimation. The hearing was normal and the taste sensation of anterior two-thirds of tongue was intact. There was a firm to hard consistency swelling on right face in relation to mandible.

Back 10

Parotid Gland Tumor involve facial nerve within.

Partial involvement of muscles of face common.

Indicates the lesion in the parotid gland

Since facial nerve divides within the parotid.

Peri-neural spread of certain skin tumors.

Infra temporal fossa tumors also produce

Front 11

In this 75 year-old man there is a mask like face, complete lack of normal play of expression and diminished rate of blinking of the eyes. Yet when it occurs it is normal. The patient is able to show the teeth and say “yee”. There is interrupted rigidity; but no pyramidal signs as such.

Back 11

Occurs in Parkinsonism

Bilateral UMN Emotional Facial palsy.

Volitional movements are preserved

This often causes difficulty in detection

Because symmetry of face maintained

Rigidity due to extra-pyramidal involvement

Front 12

In this 65 year-old woman the face was mostly expressionless but out bursts of emotions and inappropriate emotions occurred frequently. Blinking of eyes was little affected; but the mouth could not be moved on command. Yet often moved during ordinary conversations. Plantar is bilaterally extensor.

Back 12

Bilateral UMN Facial volitional Facial Palsy.

Jaw jerk is exaggerated or brisk

Bilateral brisk reflexes are observed

Usually secondary to a multi infarct state.

Also called as Pseudobulbar Palsy.

It is seen in in bilateral cerebrovascular accident

Front 13

In this 35 year-old woman there is flattening of all normal folds of the face, the corners of the mouth are sagging and all attempts at voluntary movements of the face fail. The whites of the eyes are seen on either sides when the patient attempts to close them. The patient talks as if protecting a sore mouth.

Back 13

Bilateral LMN Facial Palsy.

Most classically due to Gullain Barre Syndrome.

Both emotional and volitional affected

Since LMN is the common final pathway

A/c infective demyelinating polyneuropathy

Life threatening disorder when respiration affect

Front 14

In this diabetic patient in addition to an LMN type of facial palsy there is also a third nerve paralysis which spared the pupils.The LMN facial was not accompanied by any decrease in lacrimation, hyperacusis of hearing or taste sensation of the tongue. No long tract signs or cerebellar signs.

Back 14

Mononeuritis Multiplex Cranialis

Occurs in classically in Diabetes Mellitus,

Hansens disease is an important cause

Sarcoidosis may also produce similar lesions

SLE or other vasculitis may behave similarly

Basal meningitis does not involve VII

Front 15

In this 25 year-old woman,the illness started at the age of ten years and gradually progressed over several years. There is loss of fat in the dermal and subcutaneous tissues on one side of face. O/E affected side of the face is gaunt, and the skin, thin, wrinkled, & rather brown in colour.

Back 15

Facial Hemiatrophy of Romberg.

Actually it is a case of lipoatrophy.

The sebaceous glands become atrophic

Sometimes atrophy may become bilateral

Facial nerve is essentially normal.

Treatment is with facial muscle reconstruction.

Front 16

In this 65 year-old woman who developed a Bell’s palsy on the right side of face, upon recovery, the angle of mouth was forcefully deviating to the right side itself. This was just the opposite of what she was having at the onset of the problem. She also had persistent twitching on same side.

Back 16

Hemifacial Spasm

More often due irritation of the facial nerve

due to compression by an aberrant artery.

Or a basilar artery aneurysmAn acoustic neuroma may be the cause

Treatment with carbamazepine or baclofen

Front 17

This 35 year-old woman presented with history
of recurrent facial paralysis and recurrent facial
oedema, which eventually became permanent. She also developed folds and furrows on the
tongue. The lip become hard, cracked, and
fissured with a reddish-brown discoloration.

Back 17

Melkerson Rosenthal syndrome

A rare neurological disorder.

Recurrent attacks ranging from days to years.

The cause of the syndrome is unknown.

But there may be a genetic predisposition.

Treatment is symptomatic may be NSAIDs.