DOCSLIB.ORG

Bell Palsy: Clinical Examination and Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bell Palsy: Clinical Examination and Management REVIEW CME EDUCATIONAL OBJECTIVE: Readers will distinguish Bell palsy from other causes of facial weakness CREDIT and apply current management guidelines DONIKA K. PATEL, DO KERRY H. LEVIN, MD Division of Neurology, LeBauer HealthCare, Chairman, Department of Neurology; Director, Cone Health Medical Group, Greensboro, NC Neuromuscular Center, Neurological Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Bell palsy: Clinical examination and management ABSTRACT ell palsy is an idiopathic peripheral nerve Bdisorder involving the facial nerve (ie, cra- Bell palsy is a common neurologic disorder characterized nial nerve VII) and manifesting as acute, ipsi- by acute facial mononeuropathy of unclear cause pre- lateral facial muscle weakness. It is named after senting with unilateral facial weakness. Careful exami- Sir Charles Bell, who in 1821 first described the nation and a detailed history are important in making anatomy of the facial nerve.1 Although the dis- an accurate diagnosis. Early recognition is essential, as order is clinically benign, patients can be dev- treatment with corticosteroids within 72 hours of onset astated by its disfigurement. has been shown to hasten recovery. Fortunately, most The annual incidence of Bell palsy is 20 per patients recover spontaneously within 3 weeks, even if 100,000, with no predilection for sex or eth- untreated. nicity. It can affect people at any age, but the incidence is slightly higher after age 40.2,3 Risk KEY POINTS factors include diabetes, pregnancy, severe preeclampsia, obesity, and hypertension.4–7 Bell palsy is an acute disorder of the facial nerve caus- ing unilateral facial weakness, pain, abnormal taste, and ■ THE FACIAL NERVE IS VULNERABLE reduced tearing. TO TRAUMA AND COMPRESSION A basic understanding of the neuroanatomy of Although herpes simplex virus reactivation is suspected the facial nerve provides clues for distinguish- in the pathogenesis, the exact cause is unknown. ing a central lesion from a peripheral lesion. This differentiation is important because the An additional workup is warranted for abnormalities causes and management differ. beyond isolated facial nerve palsy. The facial nerve is a mixed sensory and motor nerve, carrying fibers involved in facial expression, taste, lacrimation, salivation, and Guidelines recommend starting corticosteroids for sensation of the ear. It originates in the lower patients who present within 3 days of symptom onset. pons and exits the brainstem ventrally at the There is no compelling evidence to support antiviral pontomedullary junction. After entering the therapy, physical therapy, acupuncture, or surgical internal acoustic meatus, it travels 20 to 30 mm decompression. in the facial canal, the longest bony course of any cranial nerve, making it highly susceptible to trauma and compression by edema.8 In the facial canal, it makes a posterior and inferior turn, forming a bend (ie, the genu of the facial nerve). The genu is proximal to the geniculate ganglion, which contains the fa- cial nerve’s primary sensory neurons for taste and sensation. The motor branch of the facial doi:10.3949/ccjm.82a.14101 nerve then exits the cranium via the stylomas- CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 82 • NUMBER 7 JULY 2015 419 Downloaded from www.ccjm.org on September 28, 2021. For personal use only. All other uses require permission. BELL PALSY TABLE 1 herpes virus simplex type 1 infection may be involved.10 Approach to the clinical examination for Bell palsy ■ FACIAL DROOPING, EYELID WEAKNESS, Observe for asymmetry during the interview; pay close attention OTHER SYMPTOMS to blinking, the nasolabial folds, and the corners of the mouth Symptoms of Bell palsy include ipsilateral sag- General examination, otoscopy, palpation for masses near the neck ging of the eyebrow, drooping of the face, flat- and face, and examination of the skin tening of the nasolabial fold, and inability to Assess motor function, asking the patient to: fully close the eye, pucker the lips, or raise the Raise both eyebrows corner of the mouth (Figure 1). Symptoms Close both eyes tightly develop within hours and are maximal by 3 Smile days. Puff out the cheeks About 70% of patients have associated Purse the lips Show both upper and lower teeth (grimace) ipsilateral pain around the ear. If facial pain is present with sensory and hearing loss, a tu- Assess special sensory function, if clinically indicated mor of the parotid gland or viral otitis must be Sensation of the face and ear considered.11 Other complaints may include Taste sensation of anterior two-thirds of the tongue hyperacusis due to disruption of nerve fibers to Assess reflexes the stapedius muscle, changes in taste, and dry Orbicularis reflex: tap the glabella and observe asymmetry in blink eye from parasympathetic dysfunction. Some pattern patients report paresthesias over the face, Bell phenomenon: observe upward movement of eyes which most often represent motor symptoms during forced eye-closure misconstrued as sensory changes. Isolated unilateral or asymmetric facial weakness in the absence of other cranial neu- ■ PHYSICAL EXAMINATION ropathy supports the diagnosis of Bell palsy. The clinical examination should include a complete neurologic and general examina- Although toid foramen and passes through the parotid tion, including otoscopy and attention to gland, where it divides into temporofacial and Bell palsy 9 the skin and parotid gland. Vesicles or scab- cervicofacial trunks. bing around the ear should prompt testing for is clinically The facial nerve has five terminal branches herpes zoster. Careful observation during the benign, its that innervate the muscles of facial expression: interview while the patient is talking may re- • The temporal branch (muscles of the fore- disfigurement veal subtle signs of weakness and provide ad- head and superior part of the orbicularis ditional clues. can be oculi) A systematic approach to the assessment devastating • The zygomatic branch (muscles of the of a patient with suspected Bell palsy is recom- nasolabial fold and cheek, eg, nasalis and mended (Table 1) and outlined below: zygomaticus). • The buccal branch (the buccinators and Does the patient have peripheral facial palsy? inferior part of the orbicularis oculi) In Bell palsy, wrinkling of the forehead on the • The marginal mandibular branch (the de- affected side when raising the eyebrows is ei- pressors of the mouth, eg, depressor anguli ther asymmetrical or absent. and mentalis) If the forehead muscles are spared and the • The cervical branch (the platysma muscle). lower face is weak, this signifies a central le- sion such as a stroke or other structural abnor- ■ INFLAMMATION IS BELIEVED mality and not a peripheral lesion of the facial TO BE RESPONSIBLE nerve (eg, Bell palsy). Although the precise cause of Bell palsy is not Can the patient close the eyes tightly? known, one theory is that inflammation of the Normally, the patient should be able to close nerve causes focal edema, demyelination, and both eyes tightly, and the eyelashes should be ischemia. Several studies have suggested that buried between the eyelids. In Bell palsy, when 420 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 82 • NUMBER 7 JULY 2015 Downloaded from www.ccjm.org on September 28, 2021. For personal use only. All other uses require permission. PATEL AND LEVIN Facial asymmetry in Bell palsy The facial nerve is a mixed sensory and motor nerve, carrying fibers involved in facial expression, taste, lacrimation, salivation, and sensation of the ear. Bell palsy, due to dysfunction of the facial nerve, typically causes paralysis or weakness of the muscles on one side of the face. In the patient below, the left side of the face is affected, causing: Inability to furrow the brow on the affected side Slight widening of the palpebral fissure Drooping of the corner of the mouth CCF Medical Illustrator: Jeff Loerch ©2015 FIGURE 1 the patient attempts to close the eyes, the af- involved side in Bell palsy may slightly lag be- fected side shows incomplete closure and the hind the normal eye, and the patient may be eye may remain partly open. unable to close the eye completely. Assess the strength of the orbicularis oculi by trying to open the eyes. The patient who Is the smile symmetric? is attempting to close the eyelids tightly but Note flattening of the nasolabial fold on one cannot will demonstrate the Bell phenom- side, which indicates facial weakness. enon, ie, the examiner is able to force open the eyelids, and the eyes are deviated upward Can the patient puff out the cheeks? and laterally. Ask the patient to hold air in the mouth Closely observe the blink pattern, as the against resistance. This assesses the strength CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 82 • NUMBER 7 JULY 2015 421 Downloaded from www.ccjm.org on September 28, 2021. For personal use only. All other uses require permission. BELL PALSY of the buccinator muscle. eyelid closure. In this reflex, the afferent fibers are carried by the facial nerve and the efferent Can the patient purse the lips? fibers travel in the oculomotor nerve to the Ask the patient to pucker or purse the lips and superior rectus muscle. In Bell palsy, this reflex observe for asymmetry or weakness on the af- is visible because of failure of adequate eyelid fected side. closure. Test the orbicularis oris muscle by trying to The corneal reflex is elicited by stimulat- spread the lips apart while the patient resists, ing the cornea with a wisp of cotton, causing and observe for weakness on one side. reflexive closure of the both eyes. The affect- ed side may show slowed or absent lid closure Is there a symmetric grimace? when tested on either side. The sensory affer- This will test the muscles involved in depress- ent fibers are carried by the trigeminal nerve, ing the angles of the mouth and platysma.
Load more

Recommended publications
  • Imaging of Nontraumatic Temporal Bone Emergencies Nitesh Shekhrajka, MD and Gul Moonis, MD
    Imaging of Nontraumatic Temporal Bone Emergencies Nitesh Shekhrajka, MD and Gul Moonis, MD This section aims to cover the non-traumatic pathologies affecting the temporal bone including external auditory canal, middle ear and inner ear which usually need emergent clinical attention. Many of the conditions in this section are secondary to infections in differ- ent clinical settings with resultant complications which may leave temporary or permanent sequelae if not suspected, timely diagnosed or treated. Semin Ultrasound CT MRI 40:116-124 © 2018 Elsevier Inc. All rights reserved. External Auditory Canal There is abnormal soft tissue thickening and enhancement along the margins of the EAC, auricle, and periauricular soft Malignant Otitis Externa tissue. There is effacement of the fat planes around the stylo- his is a more aggressive form of acute otitis externa mastoid foramen and infratemporal fossa5. The involvement T which affects the elderly, diabetic, and immunocompro- of the stylomastoid foramen may result in facial nerve mised patients.1 The term “Malignant” is a misnomer used to involvement. Opacification of middle ear cavity and mastoid describe the aggressive clinical nature and high mortality in air cells are frequently seen (Fig. 1). this condition. It is also referred to as necrotizing otitis If the disease extends inferiorly to involve the subtemporal externa (NOE). In most cases, the causative pathogen is Pseu- soft tissues, parotid, masticator, and parapharyngeal spaces, domonas aeruginosa2 which is not normally found in the imaging will demonstrate abnormal soft tissue enhancement, external acoustic meatus (EAC) but Aspergillus fumigatus is diffuse enlargement of the surrounding muscles, parotid also implicated in immunocompromised patients.3 enlargement, and effacement of the fat planes with or with- The infection begins as an area of granulation at the junc- out abscess.
    [Show full text]
  • Entrapment Neuropathy of the Central Nervous System. Part II. Cranial
    Entrapment neuropathy of the Cranial nerves central nervous system. Part II. Cranial nerves 1-IV, VI-VIII, XII HAROLD I. MAGOUN, D.O., F.A.A.O. Denver, Colorado This article, the second in a series, significance because of possible embarrassment considers specific examples of by adjacent structures in that area. The same entrapment neuropathy. It discusses entrapment can occur en route to their desti- nation. sources of malfunction of the olfactory nerves ranging from the The first cranial nerve relatively rare anosmia to the common The olfactory nerves (I) arise from the nasal chronic nasal drip. The frequency of mucosa and send about twenty central proces- ocular defects in the population today ses through the cribriform plate of the ethmoid bone to the inferior surface of the olfactory attests to the vulnerability of the optic bulb. They are concerned only with the sense nerves. Certain areas traversed by of smell. Many normal people have difficulty in each oculomotor nerve are pointed out identifying definite odors although they can as potential trouble spots. It is seen perceive them. This is not of real concern. The how the trochlear nerves are subject total loss of smell, or anosmia, is the significant to tension, pressure, or stress from abnormality. It may be due to a considerable variety of causes from arteriosclerosis to tu- trauma to various bony components morous growths but there is another cause of the skull. Finally, structural which is not usually considered. influences on the abducens, facial, The cribriform plate fits within the ethmoid acoustic, and hypoglossal nerves notch between the orbital plates of the frontal are explored.
    [Show full text]
  • Morfofunctional Structure of the Skull
    N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]
  • Morphometric Analysis of Stylomastoid Foramen Location and Its Clinical Importance
    Dental Communication Biosc.Biotech.Res.Comm. Special Issue Vol 13 No 8 2020 Pp-108-111 Morphometric Analysis of Stylomastoid Foramen Location and its Clinical Importance Hemanth Ragav N V1 and Yuvaraj Babu K2* 1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai- 600077, India 2Assistant Professor, Department of Anatomy, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai- 600077, India ABSTRACT The stylomastoid foramen is located between the styloid process and mastoid process of the temporal bone. Facial nerve and Stylomastoid branch of posterior auricular artery passes through this stylomastoid foramen. The facial nerve can be blocked at this stylomastoid foramen but it has high risk of nerve damage. For Nadbath facial nerve block, stylomastoid foramen is the most important site. Facial canal ends at this foramen and it is the important motor portion of this stylomastoid foramen. A total of 50 dry skulls from the Anatomy Department of Saveetha Dental College were studied to locate the position of the centre of the stylomastoid foramen with respect to the tip of mastoid process and the articular tubercle of the zygomatic arch by a digital vernier caliper. All measurements were tabulated and statistically analysed. In our study, we found the mean distance of stylomastoid foramen from mastoid processes 16.31+2.37 mm and 16.01+2.08 mm on right and left. Their range is 10.48-23.34 mm and 11.5-21.7 mm. The mean distance of stylomastoid foramen from articular tubercle is 29.48+1.91 mm and 29.90+1.62 mm on right and left.
    [Show full text]
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • Topographical Anatomy and Morphometry of the Temporal Bone of the Macaque
    Folia Morphol. Vol. 68, No. 1, pp. 13–22 Copyright © 2009 Via Medica O R I G I N A L A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl Topographical anatomy and morphometry of the temporal bone of the macaque J. Wysocki 1Clinic of Otolaryngology and Rehabilitation, II Medical Faculty, Warsaw Medical University, Poland, Kajetany, Nadarzyn, Poland 2Laboratory of Clinical Anatomy of the Head and Neck, Institute of Physiology and Pathology of Hearing, Poland, Kajetany, Nadarzyn, Poland [Received 7 July 2008; Accepted 10 October 2008] Based on the dissections of 24 bones of 12 macaques (Macaca mulatta), a systematic anatomical description was made and measurements of the cho- sen size parameters of the temporal bone as well as the skull were taken. Although there is a small mastoid process, the general arrangement of the macaque’s temporal bone structures is very close to that which is observed in humans. The main differences are a different model of pneumatisation and the presence of subarcuate fossa, which possesses considerable dimensions. The main air space in the middle ear is the mesotympanum, but there are also additional air cells: the epitympanic recess containing the head of malleus and body of incus, the mastoid cavity, and several air spaces on the floor of the tympanic cavity. The vicinity of the carotid canal is also very well pneuma- tised and the walls of the canal are very thin. The semicircular canals are relatively small, very regular in shape, and characterized by almost the same dimensions. The bony walls of the labyrinth are relatively thin.
    [Show full text]
  • Dissection and Exposure of the Whole Course of Deep Nerves in Human Head Specimens After Decalcification
    Hindawi Publishing Corporation International Journal of Otolaryngology Volume 2012, Article ID 418650, 7 pages doi:10.1155/2012/418650 Research Article Dissection and Exposure of the Whole Course of Deep Nerves in Human Head Specimens after Decalcification Longping Liu, Robin Arnold, and Marcus Robinson Discipline of Anatomy and Histology, University of Sydney, Anderson Stuart Building F13, Sydney, NSW 2006, Australia Correspondence should be addressed to Marcus Robinson, [email protected] Received 29 July 2011; Revised 10 November 2011; Accepted 12 December 2011 AcademicEditor:R.L.Doty Copyright © 2012 Longping Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The whole course of the chorda tympani nerve, nerve of pterygoid canal, and facial nerves and their relationships with surrounding structures are complex. After reviewing the literature, it was found that details of the whole course of these deep nerves are rarely reported and specimens displaying these nerves are rarely seen in the dissecting room, anatomical museum, or atlases. Dissections were performed on 16 decalcified human head specimens, exposing the chorda tympani and the nerve connection between the geniculate and pterygopalatine ganglia. Measurements of nerve lengths, branching distances, and ganglia size were taken. The chorda tympani is a very fine nerve (0.44 mm in diameter within the tympanic cavity) and approximately 54 mm in length. The mean length of the facial nerve from opening of internal acoustic meatus to stylomastoid foramen was 52.5 mm.
    [Show full text]
  • The Role of Facial Canal Diameter in the Pathogenesis and Grade of Bell's Palsy
    Braz J Otorhinolaryngol. 2017;83(3):261---268 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE The role of facial canal diameter in the pathogenesis and grade of Bell’s palsy: a study by high resolution ଝ computed tomography a a b a,∗ Onur Celik , Gorkem Eskiizmir , Yuksel Pabuscu , Burak Ulkumen , c Gokce Tanyeri Toker a Celal Bayar University, School of Medicine, Department of Otorhinolaryngology, Manisa, Turkey b Celal Bayar University, School of Medicine, Department of Radiology, Manisa, Turkey c Gelibolu State Hospital, Department of Otorhinolaryngology, Gelibolu, Turkey Received 20 February 2016; accepted 23 March 2016 Available online 29 April 2016 KEYWORDS Abstract Facial canal; Introduction: The exact etiology of Bell’s palsy still remains obscure. The only authenticated Facial nerve; finding is inflammation and edema of the facial nerve leading to entrapment inside the facial Bell’s palsy; canal. Idiopathic facial Objective: To identify if there is any relationship between the grade of Bell’s palsy and diameter paralysis; of the facial canal, and also to study any possible anatomic predisposition of facial canal for Computed Bell’s palsy including parts which have not been studied before. tomography Methods: Medical records and temporal computed tomography scans of 34 patients with Bell’s palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House- Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records.
    [Show full text]
  • Variations in the Morphology of Stylomastoid Foramen: a Possible Solution to the Conundrum of Unexplained Cases of Bell’S Palsy S.K
    Folia Morphol. Vol. 80, No. 1, pp. 97–105 DOI: 10.5603/FM.a2020.0019 O R I G I N A L A R T I C L E Copyright © 2021 Via Medica ISSN 0015–5659 eISSN 1644–3284 journals.viamedica.pl Variations in the morphology of stylomastoid foramen: a possible solution to the conundrum of unexplained cases of Bell’s palsy S.K. Ghosh , R.K. Narayan Department of Anatomy, All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar, India [Received: 12 January 2020; Accepted: 2 February 2020] Background: Stylomastoid foramen is the terminal part of facial canal and is the exit gateway for facial nerve from skull base. We hypothesized that anatomical variations of this foramen could be a risk factor for the injury of facial nerve re- sulting in unilateral facial nerve paralysis or Bell’s palsy. Hence the present study was conducted to study the variations in size and shape of stylomastoid foramen in dry adult human skulls. Materials and methods: The study was conducted on 37 dry adult human skulls of unknown age and sex. High resolution images of the skulls under study were processed by ImageJ software and observations were undertaken. Results: Total eight variations of stylomastoid foramen were observed in terms of shape. The common variants were round, oval and square (present in 83.79% skulls on right side and 81.07% skulls on left side), whereas the rare variants were triangular, rectangular, serrated, bean-shaped and irregular. It was noted that stylomastoid foramen were associated with extensions (45.95% skulls) and also adjacent foramen (18.92% skulls).
    [Show full text]
  • Facial Baroparesis Mimicking Stroke
    CASE REPORT Facial Baroparesis Mimicking Stroke Diann M. Krywko, MD* *Medical University of South Carolina, Department of Emergency Medicine, Charleston, D. Tyler Clare, MD* South Carolina Mohamad Orabi, MD† †Medical University of South Carolina, Department of Neurology, Charleston, South Carolina Section Editor: Rick A. McPheeters, DO Submission history: Submitted September 21, 2017; Revision received February 10, 2018; Accepted January 10, 2018 Electronically published March 14, 2018 Full text available through open access at http://escholarship.org/uc/uciem_cpcem DOI: 10.5811/cpcem.2018.1.36488 We report a case of a 55-year-old male who experienced unilateral facial muscle paralysis upon ascent to altitude on a commercial airline flight, with resolution of symptoms shortly after descent. The etiology was determined to be facial nerve barotrauma, or facial baroparesis, which is a known but rarely reported complication of scuba diving, with even fewer cases reported related to aviation. The history and proposed pathogenesis of this unique disease process are described. [Clin Pract Cases Emerg Med.2018;2(2):136-138.] INTRODUCTION noted left upper and lower facial droop along with Facial baroparesis is a seventh cranial nerve palsy dysarthria. Vital signs including blood pressure were within caused by transient hypoxemia of the facial nerve normal limits. Forty-five minutes after symptom onset, an secondary to increased pressure in the middle ear cavity. It emergency landing was initiated. Upon descent, the patient has classically been reported in divers, with isolated cases reported that the pressure sensation started to decrease in reported in the aviation literature.1,2,3,4 The facial nerve his left ear, and suddenly his left ear “popped,” leading to travels through the tympanic segment of the facial canal.
    [Show full text]
  • Large Vestibular Aqueduct and Congenital Sensorineural Hearing Loss
    Large Vestibular Aqueduct and Congenital Sensorineural Hearing Loss Mahmood F. Mafee, 1 Dale Char/etta, Arvind Kumar, and Hera/do Belmonf From the Department of Radiology, University of Illinois at Chicago (MAM), the Department of Radiology, Rush-Presbyterian-St. Luke's Medical Center (DC), and the Department of Otolaryngalogy-Head and Neck Surgery, University of Illinois at Chicago (AK) The inner ear is composed of the membranous All of the structures of the membranous laby­ labyrinth and the osseous labyrinth (1). The mem­ rinth are enclosed within hollowed-out bony cav­ branous labyrinth has two major subdivisions, a ities that are considerably larger than their mem­ sensory portion called the sensory labyrinth and branous contents. These bony cavities assume a nonsensory portion designated the nonsensory the same shape as the membranous chambers labyrinth. and are referred to as the osseous labyrinth. The The sensory labyrinth lies within the petrous bony cavities of the osseous labyrinth are lined portion of the temporal bone. It contains two by periosteum and contain fluid, known as peri­ intercommunicating portions: 1) the cochlear lab­ lymph, that bathes the external surface of the yrinth that consists of the cochlea and is con­ membranous labyrinth. The perilymph is rich in cerned with hearing, and 2) the vestibular laby­ . sodium ions and poor in potassium ions and is rinth that contains the utricle, saccule, and sem­ roughly comparable with extracellular tissue fluid icircular canals, all of which are concerned with or cerebrospinal fluid (CSF). It appears to act as equilibrium. These hollow chambers are filled a hydraulic shock absorber to protect the mem­ with fluid, known as endolymph, that resembles branous labyrinth.
    [Show full text]