a case of lower motor neuron facial nerve palsy
â˘Download as PPT, PDFâ˘
32 likesâ˘7,479 views
27 year old woman with lower motor neuron facial nerve palsy with no cause bells palsy
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to a case of lower motor neuron facial nerve palsy
Similar to a case of lower motor neuron facial nerve palsy (20)
More from Samten Dorji
Recently uploaded
Recently uploaded (20)
a case of lower motor neuron facial nerve palsy
- 1. Case presentation Dr. Samten Dorji
- 2. Chief complaint ⢠A 27 year old woman presented to the eye OPD clinic with weakness in left side of face for 2 weeks duration She is a monk from Punakha dzongkhag
- 3. History of chief complaint ⢠2 weeks back she had a sudden onset of left side facial weakness and pain in the left ear which lasted for first three days ⢠She had difficulty in closing her left eye and had on and off watery discharge. She complains of mild drooling. ⢠No previous episode ⢠There was no history of trauma
- 4. History cont. ⢠Systemic review ⢠Past ocular history/ocular medications/systemic medications/ comorbidities/allergies/family history
- 5. Examination ⢠Asymmetry of the face ⢠Absent wrinkling of left forehead ⢠Inability to close left eye(lagophthalmus) ⢠Mouth deviated to the right side ⢠Unable to puff out left cheek
- 8. Right eye Left eye Visual acuity 6/6 6/6 With pinhole Color vision Normal Normal Extraocular movements Normal Normal Bellâs phenomenon Present Lids and adnexa Normal Normal Schirmerâs test 15mm 15mm Conjunctiva and sclera normal normal Cornea clear Clear( sensation intact) Anterior chamber Normal depth and quiet Normal depth and quiet Iris and lens Normal Normal Pupil Round regular and reactive Round regular and reactive Dilated fundus Vessel sheathing and healed scars Normal
- 9. Case summary ⢠A 27 year old female presented with weakness in left side of face for 2 weeks with difficulty in closing the left eye and left earache for initial 3 days.neurological examination showed left lower motor neuron seventh nerve palsy. Bellâs phenomenon and corneal sensation was intact. Dilated funduscopy showed vessel sheathing and healed scars in the left fundus.
- 10. Problems ⢠Left lower motor neuron seventh nerve palsy ⢠Healed right retinal vasculitis
- 13. Diagnosis ⢠House-Brackmann grade 3 left lower motor neuron facial nerve palsy with idiopathic cause.
- 14. Differential diagnosis ⢠Infection ⢠Neoplasm ⢠Congenital ⢠Trauma
- 15. Investigation
- 17. Management Corticosteroids â˘Oral prednisolone 60mg daily for 7 days and tapered until 5mg daily â˘Anti acid medications â˘Early treatment is recommended especially within 3 days of symptoms of onset. â˘Significantly reduced mild and moderate sequelae. Facial physiotherapy â˘To help in recovery of facial nerve function â˘Prevents muscle atrophy and aids in full recovery if prognosis is good
- 18. Eye lubricants â˘To prevent exposure keratopathy â˘Depending upon the severity of keratopathy the frequency of lubricants is prescribed ENT review â˘Assessement was normal â˘To rule out any pathology causing facial nerve palsy
- 19. Lower motor neuron facial nerve palsy
- 20. Outline ⢠Introduction ⢠Anatomy ⢠Aetiology ⢠Clinical evaluation ⢠Management
- 22. Anatomy ⢠Motor fibers that innervate the facial muscles ⢠Parasympathetic fibers innervating lacrimal, submandibular, and sublingual salivary glands ⢠Afferent fibers from taste receptors from the anterior two thirds of the tongue ⢠Somatic afferents from the external auditory canal and pinna ⢠The nerve arises from two roots from the pontomedullary junction and enters the internal auditory meatus
- 23. â˘The facial (fallopian) canal= 33 mm â˘labyrinthine, tympanic, and mastoid â˘Narrowest in the labyrinthine segment (average 0.68 mm in diameter) â˘Facial nerve emerge at the stylomastoid foramen and pass through the parotid gland â˘These fibers divide into five groups of nerves between the deep and superficial lobes of the gland
- 25. Aetiology ⢠Idiopathic (Bellâs palsy) ⢠Trauma ⢠Infection ⢠Neoplasms ⢠Congenital ⢠Miscellaneous
- 26. Bellâs palsy ⢠Acute peripheral facial nerve palsy of unknown cause ⢠Diagnosis of exclusion Epidemiology â˘The annual incidence rate =13 and 34 cases per 100,000 population â˘Age=15-45 years age group â˘No race, geographic, or gender predilection â˘Risk is three times greater during pregnancy
- 27. Pathophysiology ⢠Herpes simplex virus activation is the likely cause of Bell's palsy in most cases ⢠Inflammatory and possibly infectious cause ⢠Nerve damage is maximal in the labyrinthine part of the facial canal
- 29. Trauma ⢠Second most common cause ⢠Most common is temporal bone fractures(blunt and penetrating) ⢠Iatrogenic
- 30. Infection ⢠Varicella zoster virus ⢠Lyme disease ⢠Tuberculosis ⢠Polio ⢠Mumps ⢠leprosy
- 31. Ramsay hunt syndrome â˘Geniculate ganglionitis â˘Zoster vesicles in external auditory canal or tympanic membrane(classic sign)
- 32. Neoplasms
- 33. Congenital Moebius syndrome Digeorge syndrome Coloboma Heart defects Atresia ofchoanae Retardation of growth Genital abnormalities Ear abnormalities
- 34. Miscellaneous ⢠Diabetes mellitus ⢠Hypertension ⢠Amyloidosis ⢠Sarcoidosis ⢠Multiple sclerosis ⢠Guillain-Barre syndrome ⢠Myasthenia gravis ⢠Stroke
- 37. Laboratory investigation ⢠VDRL screening ⢠Imaging studies
- 38. Management ⢠Medical ⢠Surgical Risk factors for exposure keratopathy â˘Absence of corneal sensation â˘Severe lagophthalmus â˘Absent bellâs phenomenon â˘Dry eye
- 39. Medical Avoid ocular irritants Avoid ocular irritants Spectacle side shields Botulinum injection into levator muscle
- 40. â˘Cyanoacrylate glue â˘High dose of oral corticosteroids External eyelid weights
- 41. Surgical treatment ⢠Management of corneal exposure ⢠Correction of lower eyelid ectropion ⢠Management of brow ptosis ⢠Management of chronic epiphora
- 42. Management of corneal exposure Mullerectomy and levator aponeurosis recession Mullerectomy and levator aponeurosis recession Silicone punctal plugs Temporary suture tarsorrhaphy Lateral tarsorrhaphy Medial canthoplasty Gold weight implant
- 43. Correction of lower eyelid ectropion Skin graft procedure Mid face liftMid face lift Lateral tarsal strip procedure
- 44. Management of brow ptosis blepharoplasty â˘Impairment of superior visual field â˘Cosmetic deformity â˘Pseudo- blepharoptosis
- 45. Management of chronic epiphora Dry eye â˘eye lubricants Paralytic ectropion â˘Lateral eyelid tarsal strip procedure â˘Dacryocystorhinostomy and jones tube insertion
- 46. Hypersecretion/aberrant innervation ⢠Crocodile tear syndrome(bogoraudâs syndrome) ⢠Transconjunctival intraglandular Botulinum toxin A injections
- 47. Summary ⢠Introduction ⢠Anatomy ⢠Aetiology ⢠Clinical evaluation ⢠Management
- 48. Take home message ⢠Facial paralysis can be difficult to manage ⢠Should exclude other causes before labelling it as idiopathic ⢠Multidisciplinary approach ⢠Ophthalmologist role: eye protection and aesthetic improvement
- 49. Thank you