Facial nerve & Bell’s palsy

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Facial nerve in ENT region

  • It enters ear through internal acoustic meatus
  • In the ear it passes through fallopian canal
  • Comes out through the stylomastoid foramen
  • 3 segments in the canal:
    1. Labyrinthine segment:
      • Narrowest & shortest segment: Most vulnerable to ischemia
    2. Horizontal segment
    3. Vertical segment.

  • 3 branches of facial nerve in the ear:
    1. First genu: Greater superficial petrosal nerve: Supplies lacrimal gland
    2. Second genu: Nerve to stapedius
    3. Vertical segment: Chorda tympani nerve: Supplies anterior 2/3rd of tongue (taste sensation).

Bell’s palsy

  • Idiopathic LMN type sudden onset facial palsy
  • HSV has ?probable etiological role
  • C/F:
    1. Inability to elevate the eyebrows
    2. Paralysis of forehead muscles
    3. Inability to close the eyelid: Exposure keratitis
    4. Drooping of the angle of the mouth to the affected side: saliva dribbles through the angle of mouth
    5. Hyperacusis (loss of stapedial reflex).
  • Rx:
    • DOC: Oral steroids for 3 wk
    • May give Acyclovir: If pt presents within 3 days of onset
    • Artificial tear drop
    • Prevention of exposure keratitis:
      • Patching
      • Suturing upper and lower eyelid: Tarsorrhaphy.
  • Outcome:
    • Recovery is seen in 85% cases
    • Treatment in failed cases:

 

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