Facial nerve neuropathies

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Introduction

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