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ENT
Ear Clinical Aspects of Disorders of the Facial Nerve
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
6 sections · 44 slides
First, the Nerve Itself
What it does, where it runs, and why it is easily trapped
- What this topic covers
- Why a paralysed face is more than cosmetic
- The course of the facial nerve, segment by segment
- Reading that anatomy - why the route matters
- The design flaw that makes the nerve vulnerable
- Three numbers that anchor this topic
Cause 1 - Inflammation and the Ear
When infection reaches the nerve
- The inflammatory causes - a mixed list
- Otogenic palsy: the acute form
- Otogenic palsy: the chronic form
- Otogenic paralysis: acute versus chronic at a glance
Cause 2 - Bell's Palsy
The idiopathic palsy - common, and mostly self-healing
- What Bell's palsy is, and the vicious circle behind it
- Who gets it - and the herpes clue
- A rare variant: Melkersson-Rosenthal syndrome
- Clinical features and the natural course
- Diagnosis - and reading the nerve electrically
- Differential diagnosis - what else mimics Bell's
- Treatment - calm the swelling, protect the eye
- Bell's palsy by the numbers
Cause 3 - Trauma
The second most common cause of facial palsy
- Causes of traumatic facial paralysis
- Trauma by the numbers - fracture type and timing
- Prognosis - severity and timing decide everything
- Treatment - goals and the decompression debate
- When the nerve is actually cut
Reconstructive Surgery
Rejoining, rerouting, grafting and rewiring the nerve
- First principles - what the repair depends on
- Principles of treatment
- Repair option 1 - end-to-end suture
- Perineural-fascicular nerve suture
- Repair option 2 - rerouting for bigger defects
- Rerouting the nerve to reconstruct it
- Repair option 3 - cable (autogenous) nerve grafts
- Rewiring: nerve replacement techniques
- Timing of recovery - and the 18-month deadline
- Last-resort salvage
Pulling It Together
The whole topic in one pass
- The three causes of peripheral facial palsy
- Key takeaways
- Why does swelling in the bony canal set up a 'vicious circle', and how does treatment break it?
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery