神经病学（第八版课件）-Idiopathic Facial Palsy-bi guo rong.pptVIP

Idiopathic Facial Palsy Bi guo rong Definition Idiopathic Facial palsy is also called Bell`s palsy or Facial neuritis. It is characterized by a rapid onset of facial palsy of peripheral type Etiology the cause is unclear yet It may be (1)Chill (2)inflammation of virus vasoconstriction----ischemia---edema (3)instability of autonomic nerve pathology: swelling of facial nerve Demyelination and degeneration of the axon Clinical Features It may occurs at any age usually in young adults males are commoner then females. The onset is acute. At the onset there may be pain in the mastoid region or around the angel of the jaw. The symptoms usually produce its maximum effect within several hours or one to two days. The features is paralysis of the unilateral muscles of expression. Clinical Features the upper facial paralysis the wrinkles of the brow are smoothed out Frowning and raising the eyebrow are impossible the palpebral fissure is wider and closure of the eye is impossible because of the paralysis of the orbicularis Bell’s phenomenon the palpebral fissure is wider and closure of the eye is impossible because of the paralysis of the orbicular ,when the patient attempt to close the eye ,the eye globe rolls upwards and slightly out . Clinical Features the lower facial paralysis the nasolabial furrow is smoothed out and the mouth is dropped and drawn over to the sound side the patient is unable to purse the lips and whistle Owing to paralysis of the buccinator the food tends to accumulate between the teeth and cheek. Dribbling may occur. Diagnosis and Differential Diagnosis According to the rapid onset of facial palsy of peripheral type Differential Diagnosis 1 Guillain - Barre - Syndrome 2 Otitis media. labyrinthitis 3 posterior fossa disease Treatment Acute phase prednisone 10mg tid po. 5—10days VitamineB1.B12 physiatrists the protection of the expose cornea Treatment recovering phase exercise of the paralyzed facial muscles a