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Facial paralysis

Anatomy of facial nerve:pons---internal acoustic meatus—facial canal --- middle ear (geniculate ganglia).The greater petrosal nerve to pterygopalatine ganglia ---lacrimal n. -----lacrimal gland.Nerve to stapedius muscle. chorda tympani exit from petrotympanic fissure ---united with lingual nerve 1cm below base of skull---suppling ant. 2/3 of tongue, submandibular & sublingual glands.

While facial nerve exit from stylomastoid foramen suppling post.auricular muscle & post.belly of digastric then pierce parotid gland & give fives branches to muscle of facial expression: temporal, zygomatic, buccal, marginal mandibular & cervical.

Causes of facial paralysis

Extracranial causes:
1- Bells` palsy.
2- Surgery to parotid gland
3- Tumor of parotid gland.
4- Misplace local anesthesia.
5- Melkerson rosenthal syndrome. (facial paralysis, a folded or plicated tongue dorsum, and swelling of one or both lips)
6- Heerfordets` syndrome.

Intracranial causes

1- Stroke (CVA)
2-Intracranail bleebing.
3- Intracranial thrombosis.
4- Ramzy hunt syndrome.
5- Multiple sclerosis.
6- Lymes disease.
7- Trauma to base of skull.

Bells palsy

Bell’s palsy is recognized as a unilateral paresis of the facial nerve. The dysfunction has been attributed to an inflammatory reaction involving the facial nerve. A relationship has been demonstrated between Bell’s palsy and the isolation of herpessimplex virus 1 from nerve tissues.

Clinical ManifestationsBell’s palsy begins with slight pain around one ear, followed by an abrupt paralysis of the muscles on that side of the face. The eye on the affected side stays open, the corner of the mouth drops, and there is drooling. As a result of masseter weakness, food is retained in both the upper and lower buccal and labial folds. The facial expression changes remarkably, and the creases of the forehead are flattened. Due to impaired blinking, corneal ulcerations from foreign bodies can occur. Involvement of the chorda tympani nerve leads to loss of taste perception on the anterior two-thirds of the tongue and reduced salivary secretion.

Treatment The only medical treatment that may influence the outcome is the administration of systemic corticosteroids within the first few days after the onset of paralysis. Combining steroids with antiherpetic drugs such as acyclovir may decrease the severity and length of paralysis. It is also helpful to protect the eye with lubricating drops or ointment and a patch if eye closure is not possible. Facial plastic surgery and the creation of an anastomosis between the facial and hypoglossal nerves can occasionally restore partial function and improve appearance for patients with permanent damage.


Cerebrovascular Accident or Stroke Approximately 80% of strokes are associated with the development of atherosclerosis leading to cerebral ischemia and infarction. The remaining 20% of cases are caused by cerebral hemorrhage


MULTIPLE SCLEROSIS Multiple sclerosis (MS) is a chronic neurologic disease associated with the demyelination of axons within the central nervous system.


Lyme disease bacterial infection (Borrelia burgdorferi) symptoms skin rash called erythema migrans flu-like symptoms swelling of large joints neurological problems (bells palsy) diagnosis ELISA, PCR, western blot test. Treatment oral antibiotics(doxycycline)



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