The Facial Nerve

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The Facial Nerve

• Ali Sepehr

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50 y/o male with 2 month h/o unintentional right
eye closure after a 1 yr h/o hemifacial paralysis.
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Differential Diagnosis
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History

• Approximately 1 yr prior he fell from a ladder on
  his head at work and had a 2-3 day delayed
  hemifacial paralysis and R SNHL
• Denies any h/o infections, otalgia, vertigo,
  changes in vision or taste

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Physical Exam

• TMs C,D,I,M
• Positive hemotympanum and Battles sign
• No parotid masses
• No aphasia or paralysis or paresis of trunk or
  extremities

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House-Brackmann System
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• PMHx HTN, hypercholestrolemia
• PSHx R canthoplasty
• Meds Atacand and Atenolol
• All NKDA
• SHx social ETOh and 1 pipe/day for 10 yrs, quit
  15 yrs ago.

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CT
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Anatomy
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Segments
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Extratemporal segments
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Tympanomastoid suture
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Nerve Fiber Components
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EMG and ENoG
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Schirmer test
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Trigeminofacial (Blink) Reflex
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Bells Palsy, trauma
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Congenital facial palsy
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Neoplasms
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Hyperthyroidism
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Stroke
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Myasthenia Gravis
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Neurorrhaphy
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Hypoglossal-Facial Crossover
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Cross face nerve graft
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Static Procedures
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Temporalis Transposition
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Masseter Transposition
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Gold Weight