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Wednesday, December 16, 2015

Physiotherapy and Facial Palsy Tester Procedure

·         Incidence of cranial nerve injury among head trauma patients ranges between 5 and 23 percent
·         The CNI (olfactory nerve), CNVII (facial nerve), and CNVIII (acoustic nerve) cranial nerves are the ones most frequently affected.
·         The facial nerve (CN VII) :most commonly damaged motor cranial nerve. [6]
·         Lower motor neuron facial palsy type.

Facial nerve (CNVII)
·         Primary motor cortex (above parietal lobe).
·         Emerges from brainstem between pons and medulla
·         Existing from stylomastoid foramen
·         Enters the parotid gland.
·         Two main divisions.

Traumatic injuries to the facial nerve
·         By site:
o   Extracranial
o   Intratemporal
o   Intracranial
·         By type of trauma:
o   Penetrating
o   Non-penetrating
o   Iatrogenic

Extracranial facial nerve injury
·         Injured at any point after its exit from temporal bone at the stylomastoid foramen.
·         Causes:
o   Laceration
o   stab wounds
o   gunshots
o   soft tissue avulsion
o   contusion
·         Temporal division:
o   Protect cornea from eyelid weakness
·         Mandibular division:
o   Prevent drooling resulting from lower lip weakness
o   If primary repair is not possible in first 3 days, the optimal time for repair may be at 21 days after injury

Intratemporal facial nerve injury
·         Disrupting
o   bony
o   membranous labyrinth
o   the inner ear
o   facial nerve
·         Non-penetrating injury
o   Transverse fracture (hearing loss)(20%)
o   Longitudinal fracture(50%)
o   Mixed fracture
·         Penetrating injury
o   Gunshot or stab wound
o   Suspicion of vascular injury of sigmoid or lateral sinus, jugular vein or carotid system.
·         Most commonly occurs during
o   Resection of an acoustic neuroma
o   Tumor of the cerebellopontine angle (CPA)
o   Iatrogenic

Facial Nerve lesion
·         Forehead muscle function receives bilateral innervations from the motor cortex
·         Lower face receives contralateral innervation from the motor cortex

Distinguish level of Facial Nerve lesion
·         Upper Motor Neuron (UMN) /Central type
o   Paresis over contralateral side, lower part of face.
o   Unless bilateral lesion, does not affect forehead
o   Mouth paralysis is overcome by emotional expression

·         Lower Motor Neuron (LMN) /peripheral type
o   Paresis over ipsilateral forehead and lower face
o   Bell’s palsy

Facial Motor Exam
·         Forehead and Upper lid innervations
o   Eyebrow elevation
§  Occipitofrontalis, frontalis part
o   Bridge of the nose wrinkling
§  Procerus
o   Frowning
§  Corrugator supercilii
o   Tight Closing of the eyes
§  Orbicularis oculi

·         Lower Face innervations
o   Lip closing
§  Orbicularis oris
o   Cheek compression
§   Buccinator
o   Natural smile
§  Levator anguli oris

·         General grading procedures:
o   F: functional; appears normal or only slight    impairment
o   WF: weak functional; moderate impairment that  
·         affects the degree of active motion
o   NF: nonfunctional; severe impairment
o   0: Absent


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