Facial nerve

Facial nerve remylination 2 to 4 months after hematoma removal

80% myscle degeneration after 4 months
Irreversible muscles fibrosis after 2 year
Cutaneous sensory receptor die after 3 years
Grade 1 and 2 recover completely
Grade 3 partially
Grade 4 and 5 require surgical procedures
Progressive facial palsy over three weeks and palsy not recovering after 3 to 6 weeks= think of
malignancy
Bilateral most common in GB syndrome
More than 90 % degeneration in 14 days= bad prognosis
Not useful in Ramsay hunt because multiple area of involvement
Do surgery with in 3 weeks in trauma if enog is reduces more than 90% in 6 days
If acute injury in trauma explore immediately
If delayed then conservative
Fibrillation in emg after 2 to 3 weeks
Polyphasic come 6 to 12 weeks before visible clinical regeneration
If emg silent= muscle transfer or transposition
Mastoid segment least sensitive to nerve stimulation
HRCT for facial nerve. Tympanic segment on axial view
Labrynthine is banana shaped in axial
Mastoid segment on coronal or digital
Intraparotid facial nerve not recognizable by CT or MRI
T1 MRI for facial nerve av plexus esp geniculate and tympanic segments
Bells= if atypical then imaging, postgadolinium non modular appearance
AOM and CSOM = hrct
Fracture= HRCT
Tumors= MRI
Facial nerve hemangioma = honeycomb appearance on geniculate ganglion on CT intensely
postcontrast on MRI
Facial nerve schwanomma= beads on string appearance