CM ENT EXAM 2: HIGH-YIELD REVIEW
GUIDE FOR EXAM SUCCESS
a patient presents with paralysis of the right side of the face and cannot even move their eyebrows
(no forehead sparing), what do they probably have
bell's palsy
what is bell's palsy
lower motor neuron disease/peripheral lesion
what is the most likely cause of bell's palsy
reversible inflammation of the CN VII due to latent herpes virus
what are some other infectious agents that can cause facial palsy
-lyme disease= borrellia burgdorferi (spirochete)
-EBV
-HIV
-otitis media
what auditory symptom could be associated with bell's palsy
hyperacusis
why would bell's palsy cause hyperacusis
the facial nerve controls the stapedius m. that regulates sound intensity
if the facial n. is paralyzed hyperacusis can result
what are some other symptoms associated with Bell's Palsy
-decreased tear production
-altered taste on anterior 2/3 of tongue (salty, sweet, umami)
just think about facial nerve functions
,what are some symptoms that may precede Bell's Palsy
-otalgia
-aural fullness
-facial or retroauricular pain
what is treatment for bell's palsy
give prednisone (corticosteroid) and antivirals if warranted within 72 hours
-increased likelihood of full recovery
-corticosteroid should be offered to ALL Bell's Palsy pts
when does an antiviral have to be used to treat bell's palsy
if the patient has a vesicular rash or severe to complete facial paralysis
what must be done to the eye in patients with bell's palsy
protect the cornea from abrasions/drying out
-artificial tears, ophthalmic ointment, nightly patch or eyelid tape
-most common complication of Bell's palsy is corneal trauma
what is supranuclear facial paresis
upper motor neuron disorder/central lesion causing facial paralysis that is forehead sparing
what could cause a supranuclear facial paresis
stroke
tumor
seizure
etc.
what does the presence of forehead sparing with facial paralysis warrant
further evaluation with CT/MRI
-non-con CT if stroke suspected to check for bleed
-MRI is gold standard
what is the Bell Phenomenon
reflexive rolling upwards of eyeball during attempted eyelid closure when eyelid is paralyzed
when should additional work up be considered when Bell's Palsy is suspected (i.e. no forehead
sparing)
-atypical presentation
, -Lyme endemic areas
-no improvement within 4 months
-slow progression beyond 3 weeks
what are intratemporal causes of facial weakness
-idiopathic bell's palsy
-surgical trauma vs temporal bone fracture
-neoplasms (glomus jugulare tumore, facial nerve neuroma, cholesteatoma)
what are some extracranial causes of facial weakness
-parotid gland cancer/surgery/injury
-neonatal facial nerve injury
what are risk factors for Bell's Palsy
-diabetes
-pregnancy (esp 3rd trimester-> 3x increased risk)
-MS
what is neuropraxia
traumatic peripheral nerve injury -> blockage of nerve conduction and transient
weakness/parasthesia/temporary loss of motor and sensory function
-expect to resolve on its own
what is the cause of Ramsay hunt syndrome
herpes zoster within the geniculate ganglion
where would vesicles from ramsay hunt syndrome appear
outer ear and under tongue
where do anterior nose bleeds originate
Kesselbach's plexus/Little Area
-contains anterior ethmoid a. from ophthalmic a., superior labial a. from facial
a., sphenopalatine and greater palatine aa. from maxillary a.
where do posterior nose bleeds originate
usually from Woodruff's plexus
-contains pharyngeal and posterior nasal aa. of sphenopalatine a
GUIDE FOR EXAM SUCCESS
a patient presents with paralysis of the right side of the face and cannot even move their eyebrows
(no forehead sparing), what do they probably have
bell's palsy
what is bell's palsy
lower motor neuron disease/peripheral lesion
what is the most likely cause of bell's palsy
reversible inflammation of the CN VII due to latent herpes virus
what are some other infectious agents that can cause facial palsy
-lyme disease= borrellia burgdorferi (spirochete)
-EBV
-HIV
-otitis media
what auditory symptom could be associated with bell's palsy
hyperacusis
why would bell's palsy cause hyperacusis
the facial nerve controls the stapedius m. that regulates sound intensity
if the facial n. is paralyzed hyperacusis can result
what are some other symptoms associated with Bell's Palsy
-decreased tear production
-altered taste on anterior 2/3 of tongue (salty, sweet, umami)
just think about facial nerve functions
,what are some symptoms that may precede Bell's Palsy
-otalgia
-aural fullness
-facial or retroauricular pain
what is treatment for bell's palsy
give prednisone (corticosteroid) and antivirals if warranted within 72 hours
-increased likelihood of full recovery
-corticosteroid should be offered to ALL Bell's Palsy pts
when does an antiviral have to be used to treat bell's palsy
if the patient has a vesicular rash or severe to complete facial paralysis
what must be done to the eye in patients with bell's palsy
protect the cornea from abrasions/drying out
-artificial tears, ophthalmic ointment, nightly patch or eyelid tape
-most common complication of Bell's palsy is corneal trauma
what is supranuclear facial paresis
upper motor neuron disorder/central lesion causing facial paralysis that is forehead sparing
what could cause a supranuclear facial paresis
stroke
tumor
seizure
etc.
what does the presence of forehead sparing with facial paralysis warrant
further evaluation with CT/MRI
-non-con CT if stroke suspected to check for bleed
-MRI is gold standard
what is the Bell Phenomenon
reflexive rolling upwards of eyeball during attempted eyelid closure when eyelid is paralyzed
when should additional work up be considered when Bell's Palsy is suspected (i.e. no forehead
sparing)
-atypical presentation
, -Lyme endemic areas
-no improvement within 4 months
-slow progression beyond 3 weeks
what are intratemporal causes of facial weakness
-idiopathic bell's palsy
-surgical trauma vs temporal bone fracture
-neoplasms (glomus jugulare tumore, facial nerve neuroma, cholesteatoma)
what are some extracranial causes of facial weakness
-parotid gland cancer/surgery/injury
-neonatal facial nerve injury
what are risk factors for Bell's Palsy
-diabetes
-pregnancy (esp 3rd trimester-> 3x increased risk)
-MS
what is neuropraxia
traumatic peripheral nerve injury -> blockage of nerve conduction and transient
weakness/parasthesia/temporary loss of motor and sensory function
-expect to resolve on its own
what is the cause of Ramsay hunt syndrome
herpes zoster within the geniculate ganglion
where would vesicles from ramsay hunt syndrome appear
outer ear and under tongue
where do anterior nose bleeds originate
Kesselbach's plexus/Little Area
-contains anterior ethmoid a. from ophthalmic a., superior labial a. from facial
a., sphenopalatine and greater palatine aa. from maxillary a.
where do posterior nose bleeds originate
usually from Woodruff's plexus
-contains pharyngeal and posterior nasal aa. of sphenopalatine a
