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- Central : 只有對側下半臉 (Nasolabial fold) ex: MCA stroke
- Peripheral (Bell's palsy) : 同側上下全滅
CN 7 支配對側全臉 + 同側上半臉
(上半臉是兩側的 CN 7 支配, 下半臉只有對側 CN 7 支配)
Right MCA stroke : Left central type facial palsy + Left side weakness
Facial motor nucleus is located in the lower third of the pons.
下 1/3 橋腦以下的 stroke or tumor lesion
會導致 Peripheral type facial palsy, 同側全臉無力
Bell’s palsy : Most common cause of unilateral facial paralysis
Herpes simplex virus DNA and antigens have been discovered around the facial nerve of affected patients,
leading to the suspicion that the herpes simplex virus may be the culprit.
Onset of facial paralysis is acute, with maximal symptoms in 2 - 3 days.
May be preceded by pain around or behind the ear
Facial numbness or hyperesthesia accompany paralysis
Subtle dysfunction of cranial nerves V, VIII, IX, and X (5, 8, 9, 10) may be associated;
For example, patients may also complain of decreased taste or hyperacusis 聽覺過敏 due to paralysis of the stapedius muscle.
Facial droop, effacement of wrinkles and forehead burrows,
and inability to completely close the eye.
有時額頭不明顯時, 要注意看眼睛閉緊
只要眼睛閉緊不對稱, 就指向 peripheral type
還有舌頭味覺喪失, 是指向 Peripheral, 但不一定能問出來
(Taste to the anterior 2/3 of the tongue)
- Infection : Herpse (Ramsay Hunt type 2), Virus (Flu), Lyme disease
- Trauma
- Tumor (Acoustic neuroma)
- Stroke (Brain stem)
- Idiopathic
The most important alternative diagnoses to exclude are ear infections and stroke !
一定要排除耳感染 + Brainstem stroke (EOM) !!!
Identify otitis media and malignant otitis,
and palpate the mastoids for tenderness,
because infections of the ear and mastoids can affect the mastoid, tympanic, labyrinthine, or meatal segments of the cranial nerve 7
Brainstem stroke may mimic Bell’s palsy
Brainstem stroke findings include peripheral facial nerve palsy and ipsilateral gaze palsy due to ischemia of the abducens nucleus.
So, test extraocular muscle function in all patients suspected of having Bell’s palsy.
Any patient with facial paralysis sparing the forehead or inability to abduct an eye should undergo neuroimaging to assess for stroke
Treatment with corticosteroids has shown significant benefit in the treatment of Bell’s palsy
Prescribe antivirals in conjunction with steroids
同時給予抗病毒藥物和類固醇合併治療有好處，可減少後遺症發生率，且副作用並無顯著增加
Prescribe ocular lubricants, such as an artificial tear replacement, to prevent the eye from drying out.
Most patients begin to recover within 3 weeks, but about 15% will have permanent paralysis.
Peripheral type 一般還是認為 virus infection 為主
不會特別去 survey 原因
一週內用 steroid, 之後用 vit B12
希望在發病初期 (48hr) 投與治療藥品
Compesolon 5 mg/tab, 4Tab TID
Strocain tab, 1 Tab QD PC
Hi-beston 50mg/tab , 1 Tab , PO, TID PC 自
Erythromycin oph. oint 0.5% 3.5g/tube , 1 qs , OD, HS
Tears Naturale 15mL/bot , 1 Drop , OD, TID自
Famvir 250mg, 2#TID
Ramsey Hunt syndrome is a herpes zoster infection of the geniculate ganglion
VZV 侵犯 geniculate ganglion (sensory ganglion of the facial nerve CN 7).
Unilateral facial nerve palsy, severe pain,
and a vesicular eruption on the face or in the auditory canal.
Cranial nerve 8 may also be involved with associated vertigo, nausea, and hearing loss.
Deafness, vertigo, and facial nerve palsy.
The diagnosis is confirmed by the presence of grouped vesicles on an erythematous base inside the external auditory canal.
Prescribe both steroids and antivirals.
Bell synkinesis :
因為神經再生亂長而動作不協調
笑的時候閉眼, 閉眼的時候嘴角往上笑
Bell phenomenon :
眼睛閉不緊而看到眼白
閉眼時眼睛往上轉是正常的
bell palsy 因為眼睛閉不緊而看到眼白
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