Facial Nerve Disorders MCQs

Steroids are the main stay of management. A patient who reports within first three days should be given acyclovir as well. Care of the eye is a very important part of management to prevent exposure keratopathy.Chances of recovery in bell's palsy are 85% and above. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Facial Nerve and its Disorders, Page number: 112

Temporal bone fracture are two types: Longitudinal fracture This is due to falling on the side. 80% of total fractures. Less dangerous. Cause Ossicular dislocation. Cause CHL Vertigo is uncommon. EAC bleeding and CSF otorrhoea are more Common Facial palsy is less common and delayed, it is due to edema of nerve. So, treatment is or oral steroids. Transverse fracture Due to Fall on front or the back. 20% of total fractures. More dangerous. Damage cochlea. Cause SNHL Vertigo is common. EAC bleeding and CSF otorrhoea less common Facial palsy is more common and immediate it is due to direct injury to nerve by fracture line. So, treatment is immediate Surgery. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Facial Nerve and its Disorders, Page number: 114

Olfactory deficits have been described in a number of neurological disorders. Olfactory dysfunction may be the first clinical sign of Alzheimer’s disease (AD) and idiopathic Parkinson’s disease (PD). In PD, bilateral olfactory deficits occur before the onset of most of the classical neurological signs. Hence smell testing maybe useful. The remaining syndromes are not associated with olfactory nerve dysfunction. Reference – Scott Brown’s Otolaryngology, Head and Neck Surgery, 8 th edition – Volume 1 – Page – 1237

Facial paralysis along with vesicular rash in the external auditory canal and pinna is seen in Ramsay HuntSyndrome(Herpes Zoster Oticus). Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 112-114.

Based on the findings given, this is a case of longitudinal fracture of temporal bone. It presents with delayed onset of facial paralysis. This should be managed by 3 weeks of steroid therapy(as the cause is oedema). Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 116.

Treatment of Bell's palsy: Oral steroids for 3 weeks. If no improvement ->Electroneuronography is done If electroneuronography shows no significant facial nerve degeneration, steroid therapy is continued with repeat assessment. Facial nerve decompression would have been done if electroneuronography showed significant facial nerve degeneration Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 113.

If there is no recovery after 3 weeks of steroid therapy, then next management is to do. Electrophysiological Nerve testing to check for extent for nerve degeneration. If significant degeneration is noted (i.e. 90% fibres show degeneration), Then treatment is switched to surgery called surgical decompression of facial nerve. If it is Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Facial Nerve and its Disorders, Page number: 113

Immediate onset facial paralysis following temporal bone fracture - Surgery in the form of nerve decompression, re-anastomosis of cut ends or cable nerve graft. Delayed onset facial paralysis following temporal bone fracture is treated conservatively like Bell's palsy. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 115.