Facial Nerve Palsy

Nathan R. Walker; Rakesh K. Mistry; Thomas Mazzoni.

Author Information
Last Update: August 3, 2021.

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Continuing Education Activity

Facial nerve palsies are a common and essential presentation

specifically to ear, nose, and throat (ENT) surgeons but also in
general medical practice too. This activity outlines the
evaluation and management of facial nerve palsies and
highlights the role of the healthcare team in managing patients
with this condition.

Objectives:

Identify the anatomical structures associated with the

course of the facial nerve.


Explain the common physical exam findings associated

with facial nerve palsies.
 

Review the appropriate evaluation of facial nerve palsies.



Identify some interprofessional team strategies for

improving care coordination and communication to
advance care for patients with facial nerve palsies and
improve outcomes.


Access free multiple choice questions on this topic.

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Introduction

Facial nerve palsies are a common and significant presentation

specifically to ear, nose, and throat (ENT) surgeons but also in
general medical practice. The facial nerve is a fundamental
structure both for communication and emotion, and as such,
functional impairment can lead to a significant deterioration in
the quality of life.[1]
A key element in the initial assessment of a patient presenting
with facial weakness is distinguishing between a lower motor
neuron (LMN) versus an upper motor neuron (UMN) palsy, as
the likely causes and, therefore, treatment for these vary
significantly. Applying anatomy to clinical history and
examination, a clinician can identify the probable cause of facial
nerve palsy and subsequently direct management appropriately.

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Etiology

Idiopathic/Bell Palsy (70%)

Most commonly, the cause for facial nerve palsy remains

unknown and has the name ‘Bell palsy.' Bell palsy has an
incidence of 10 to 40 per 100000.[2] It is a diagnosis of
exclusion.

It usually presents as a lower motor neuron lesion with total

unilateral palsy. There is thought to be a viral prodromal period,
and it can be recurrent in up to 10% of patients; however, the
presence of a facial nerve palsy tends to present fully during the
first 24 to 48 hours. [3] Damage to the nerve from compression
within the bony canal can lead to edema and secondary pressure
resulting in ischemia and reduced function. Recovery can take
up to 1 year and is incomplete in as much as 13% of patients.

Trauma (10 to 23%)

Fractures involving the petrous part of the temporal bone and

facial wounds transecting the branches of the facial nerve can
cause facial nerve palsies. It takes an incredibly large force to
fracture the temporal bone, and the clinician must look for signs
such as hemotympanum, battles sign, and nystagmus. Temporal
bone fractures usually occur unilaterally and are classified
according to the plane of fracture along the petrous ridge (i.e.,
longitudinal vs. transverse. [4] Additionally, iatrogenic injury
during otological, parotid, and acoustic neuroma surgery can
result in traumatic damage to the facial nerve and stretch injury.
Clinical history is vital in identifying the likely cause.