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Idiopathic Facial Paralysis and Herpes Zoster Oticus
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
7 sections · 105 slides
Scope and epidemiology
- Scope of this topic
- Roadmap of the topic
- Epidemiology of Bell's palsy
- Demographic distribution
Clinical presentation, diagnosis and workup
- Typical onset of Bell's palsy
- Differential diagnosis of facial paralysis
- Features that exclude Bell's palsy
- Physical examination findings
- Cranial nerve testing and serial review
- Audiometric evaluation
- Indications for imaging
- Serologic and virologic testing
- Purpose of electroneuronography
- Timing of ENoG testing
- When ENoG is not indicated
- Role of volitional electromyography
- Limitations of electrodiagnostic testing
- Electroneuronography testing schedule in acute facial paralysis
- Electrodiagnostic decision thresholds
Pathology and pathophysiology
- Historical description
- Evidence for herpes simplex virus
- Animal model of Bell's palsy
- Human histopathological findings
- Localisation to the labyrinthine segment
- Pathogenesis of the entrapment
- Meatal foramen as the site of compression
- Spectrum of nerve injury
Natural history and medical management
- Natural history of Bell's palsy
- Peitersen outcome data
- Presenting severity as a prognostic factor
- Initial management by time of presentation
- Follow-up scheduling
- Management algorithm for Bell's palsy
- Evidence for corticosteroid therapy
- Corticosteroid regimen and rationale
- Controversy over antiviral therapy
- Evidence favouring antiviral therapy
- Safety and cost of antiviral therapy
- Total paralysis protocol at presentation
- Stopping rules for electrodiagnostic follow-up
Surgical management
- Indications for facial nerve decompression
- Gantz series outcomes
- Cannon series confirmation
- Risks of middle fossa decompression
- Preoperative preparation
- Operating room setup for the middle cranial fossa approach
- Electrode placement for intraoperative electromyography
- Anaesthetic and positioning preparation
- Skin incision for the middle cranial fossa approach
- Initial exposure and brain relaxation
- Craniotomy for middle cranial fossa exposure
- Craniotomy technique details
- Dural elevation from the middle fossa floor
- Anterior limit of dural elevation
- Retractor placement
- Superior semicircular canal blue line and the 60-degree line
- Locating the superior semicircular canal
- Safe approach to the internal auditory canal
- Middle fossa exposure of the facial nerve and surrounding anatomy
- Bony exposure of the labyrinthine segment
- Avoiding the cochlea during labyrinthine drilling
- Lysis of the dural ring at the meatal foramen
- Intraoperative electromyographic localisation
- Interpreting a failed intraoperative response
- Closure of the middle fossa approach
- Wound closure and dressing
- Immediate postoperative care
- Recovery and detection of cerebrospinal fluid leak
- Reported complication profile of the Iowa series
- Technical difficulties and their avoidance
- Technical requirements for a safe operation
- Surgeon experience and case selection
- AAO-HNS position on surgical decompression
- State of the evidence for decompression
- Feasibility of a randomised controlled trial
Herpes zoster oticus and Ramsay Hunt syndrome
- Definition of herpes zoster oticus
- Distribution of the vesicular eruption
- Herpes zoster cephalicus
- Prognosis in Ramsay Hunt syndrome
- Adverse prognostic factors in Ramsay Hunt syndrome
- Diagnosis of Ramsay Hunt syndrome
- Magnetic resonance imaging findings in zoster oticus
- Natural history and treated outcomes
- Antiviral and steroid regimens in Ramsay Hunt syndrome
- Reasons decompression is not recommended in zoster
- Comparison of Bell's palsy and Ramsay Hunt syndrome
Summary and references
- Diagnostic summary
- Management summary
- Key numbers to remember
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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