Summary
Definition
History and exam
Key diagnostic factors
- single episode
- unilateral
- absence of constitutional symptoms
- involvement of all nerve branches
- keratoconjunctivitis sicca
- pain
- synkinesis
Risk factors
- intranasal influenza vaccination
- pregnancy
- upper respiratory tract infection
- black or Hispanic ancestry
- arid/cold climate
- hypertension
- family history of Bell palsy
- diabetes
Diagnostic investigations
1st investigations to order
- clinical diagnosis
- electroneuronography (ENoG) (evoked electromyography - eEMG)
- needle electromyography (EMG)
- serology for Borrelia burgdorferi
Investigations to consider
- pure-tone audiometry
- tympanometry and stapedius reflex
- MRI (gadolinium-enhanced fine-cut of facial nerve course)
- CT (fine-cut, non-enhanced)
Treatment algorithm
Contributors
Authors
Professor of Otology and Laryngology
Director, Division of Facial Plastic and Reconstructive Surgery and Director, Facial Nerve Center
President, Sir Charles Bell Society
Massachusetts Eye and Ear Infirmary and Harvard Medical School
Boston
MA
Disclosures
TH declares that she has no competing interests.
Fellow
Division of Facial Plastic and Reconstructive Surgery
Massachusetts Eye and Ear Infirmary
Boston
MA
Disclosures
NJ holds a patent on the methods and systems for functional electrical stimulation of the paralyzed face (WO2017124019A1).
Dr Tessa Hadlock and Dr Nathan Jowett would like to gratefully acknowledge Dr Vishnu Madhok, Dr Iain Swan, Dr Pauline Lockhart, Dr Michael Norbury, and Dr John Gail Neely, previous contributors to this topic. VM, IS, PL, MN, and JGN declare that they have no competing interests.
Peer reviewers
Consultant Neurologist
Barts Health NHS Trust
London
UK
Disclosures
GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences and symposia with the following companies - GSK, Astra Zeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.
Major
US Air Force
MC Program Director
Department of Neurology
MMCN
Wilford Hall Medical Center
Lackland Air Force Base
TX
Disclosures
PG declares that he has no competing interests.
Consultant in ENT/Thyroid Surgery
Arrowe Park Hospital
Upton
Wirral
UK
Disclosures
VS declares that he has no competing interests.
Use of this content is subject to our disclaimer