Bismillahirhmanirahim
Introduction
· Incidence of cranial nerve injury among head trauma patients ranges between 5 and 23 percent
· The CNI (olfactory nerve), CNVII (facial nerve), and CNVIII (acoustic nerve) cranial nerves are the ones most frequently affected.
· The facial nerve (CN VII) :most commonly damaged motor cranial nerve. [6]
· Lower motor neuron facial palsy type.
Facial nerve (CNVII)
· Primary motor cortex (above parietal lobe).
· Emerges from brainstem between pons and medulla
· Existing from stylomastoid foramen
· Enters the parotid gland.
· Two main divisions.
Traumatic injuries to the facial nerve
· By site:
o Extracranial
o Intratemporal
o Intracranial
· By type of trauma:
o Penetrating
o Non-penetrating
o Iatrogenic
Extracranial facial nerve injury
· Injured at any point after its exit from temporal bone at the stylomastoid foramen.
· Causes:
o Laceration
o stab wounds
o gunshots
o soft tissue avulsion
o contusion
· Temporal division:
o Protect cornea from eyelid weakness
· Mandibular division:
o Prevent drooling resulting from lower lip weakness
o If primary repair is not possible in first 3 days, the optimal time for repair may be at 21 days after injury
Intratemporal facial nerve injury
· Disrupting
o bony
o membranous labyrinth
o the inner ear
o facial nerve
· Non-penetrating injury
o Transverse fracture (hearing loss)(20%)
o Longitudinal fracture(50%)
o Mixed fracture
· Penetrating injury
o Gunshot or stab wound
o Suspicion of vascular injury of sigmoid or lateral sinus, jugular vein or carotid system.
· Most commonly occurs during
o Resection of an acoustic neuroma
o Tumor of the cerebellopontine angle (CPA)
o Iatrogenic
Facial Nerve lesion
· Forehead muscle function receives bilateral innervations from the motor cortex
· Lower face receives contralateral innervation from the motor cortex
Distinguish level of Facial Nerve lesion
· Upper Motor Neuron (UMN) /Central type
o Paresis over contralateral side, lower part of face.
o Unless bilateral lesion, does not affect forehead
o Mouth paralysis is overcome by emotional expression
· Lower Motor Neuron (LMN) /peripheral type
o Paresis over ipsilateral forehead and lower face
o Bell’s palsy
Facial Motor Exam
· Forehead and Upper lid innervations
o Eyebrow elevation
§ Occipitofrontalis, frontalis part
o Bridge of the nose wrinkling
§ Procerus
o Frowning
§ Corrugator supercilii
o Tight Closing of the eyes
§ Orbicularis oculi
· Lower Face innervations
o Lip closing
§ Orbicularis oris
o Cheek compression
§ Buccinator
o Natural smile
§ Levator anguli oris
· General grading procedures:
o F: functional; appears normal or only slight impairment
o WF: weak functional; moderate impairment that
· affects the degree of active motion
o NF: nonfunctional; severe impairment
o 0: Absent
wallahuaklam...
0 Response to "Physiotherapy and Facial Palsy Tester Procedure"
Post a Comment