Summary
Definition
History and exam
Key diagnostic factors
- sudden-onset (<72 hours) unilateral facial weakness
- ipsilateral severe ear/facial pain
- ipsilateral vesicular rash
- absence of constitutional symptoms
Other diagnostic factors
- dry eye
- vertigo
- hearing loss
- tinnitus
- epiphora
- altered taste
- oral lesions
- keratitis
Risk factors
- prior exposure to varicella zoster virus (VZV)
- age >50 years
- immunosuppression
- recent physiological stressor
- female sex
Diagnostic tests
1st tests to order
- clinical diagnosis
- varicella zoster virus (VZV) polymerase chain reaction (PCR)
Tests to consider
- electroneurography (evoked electromyography)
- MRI head and neck with contrast
- serology for Borrelia burgdorferi
Treatment algorithm
acute symptoms
chronic symptoms
Contributors
Authors
Jonas R. Miller, MD
Facial Plastic and Reconstructive Surgery Fellow Otolaryngology-Head & Neck Surgery
UNC Facial Nerve Center
University of North Carolina-Chapel Hill
Chapel Hill
NC
Declarações
JRM declares that he has no competing interests.
Matthew Q. Miller, MD
Assistant Professor Otolaryngology-Head and Neck Surgery
Director UNC Facial Nerve Center
University of North Carolina-Chapel Hill
Chapel Hill
NC
Declarações
MQM is a paid consultant for Checkpoint Surgical, Inc.
Revisores
Douglas J. Lanska, MD, MS, MSPH
Honorary Fellow
Department of Neurology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Declarações
DJL declares that he has no competing interests.
Mervi Kanerva, MD, PhD
Associate Professor
Senior ENT Consultant
Helsinki University Hospital
Helsinki
Finland
Declarações
MK declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Gross GE, Eisert L, Doerr HW, et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020 Jan;18(1):55-78.Texto completo Resumo
Goswami Y, Gaurkar SS. Ramsay Hunt syndrome: an introduction, signs and symptoms, and treatment. Cureus. 2023 Jan;15(1):e33688.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Bell’s palsy
- Malignant facial nerve tumor
- Benign facial nerve tumor (e.g., facial nerve schwannoma)
Mais Diagnósticos diferenciaisDiretrizes
- S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia
Mais DiretrizesConectar-se ou assinar para acessar todo o BMJ Best Practice
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