- Intermittent facial spasms or uni- or bilateral facial paralysis or paresis.
- Cause : can be immune mediated, or due to inflammation, eg otitis media , infection, myasthenia gravis , toxins, eg botulism, trauma, neoplasia, (both extracranial and intracranial), idiopathic, <75% of cases in 1 study.
- Also seen in conjunction with polyradiculoneuropathy, polyneuropathy, and hypothyroidism.
- Signs : paralysis due to trauma is probably the most common presentation.
- Diagnosis : signs, EMG, nerve conduction studies, brainstem auditory evoked reponses (BAER).
- Treatment : symptomaticfor the facial nerve paralysis, specific treatment for the primary disease may reverse the facial neuropathy.
- Prognosis : guarded for the complete return of function.
- Drooping ear.
- Paralyzed lip commissure.
- Build-up of food in the cheek on the paralyzed side.
- Deviation of the nose away from the paralyzed side, in acute disease.
- Deviation of the nose towards affected side with chronic disease (due to facial muscle contraction or fibrosis), or with hemifacial spasm.
- Menace deficit.
- Absence of palpebral/corneal reflex. (Can result in corneal pathology due to decreased tear production and lack of a mechanism to spread tears across exposed cornea.)
- Other accompanying neurologic signs:
- Ipsilateral hemiparesis, trigeminal nerve involvement, and/or signs of central vestibular disease, indicate brainstem disease.
- Ipsilateral Horner's syndrome and signs of peripheral vestibular disease indicate extracranial disease.
- Intermittent facial or hemifacial spasm.
- Bilateral facial paralysis.
Muscle twitching is commonly either muscle or CNS in origin. Facial spasm is not a usual a sign of facial neuropathy
Causes of facial or hemifacial spasm
- Guarded for full return of function to the facial nerve.
- Chronic lip paralysis may lead to permanent contracture.
Expected response to treatment
- Improvement may take place in a few weeks or months, or not at all.