Last reviewed: 5 Oct 2024
Last updated: 01 Oct 2024
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
Full details
Other diagnostic factors
- dry eye
- vertigo
- hearing loss
- tinnitus
- epiphora
- altered taste
- oral lesions
- keratitis
Full details
Risk factors
- prior exposure to varicella zoster virus (VZV)
- age >50 years
- immunosuppression
- recent physiological stressor
- female sex
Full details
Diagnostic tests
1st tests to order
- clinical diagnosis
- varicella zoster virus (VZV) polymerase chain reaction (PCR)
Full details
Tests to consider
- electroneurography (evoked electromyography)
- MRI head and neck with contrast
- serology for Borrelia burgdorferi
Full details
Treatment algorithm
ACUTE
acute symptoms
ONGOING
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
Disclosures
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
Disclosures
MQM is a paid consultant for Checkpoint Surgical, Inc.
Peer reviewers
Douglas J. Lanska, MD, MS, MSPH
Honorary Fellow
Department of Neurology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
DJL declares that he has no competing interests.
Mervi Kanerva, MD, PhD
Associate Professor
Senior ENT Consultant
Helsinki University Hospital
Helsinki
Finland
Disclosures
MK declares that she has no competing interests.
Differentials
- Bell’s palsy
- Malignant facial nerve tumor
- Benign facial nerve tumor (e.g., facial nerve schwannoma)
More DifferentialsGuidelines
- S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer