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Semin Hear 1999; 20(1): 77-91
DOI: 10.1055/s-0028-1089913
Copyright © 1999 by Thieme Medical Publishers, Inc.

Facial Paralysis: Diagnosis and Management

Paul R. Kileny* , Michael J. Disher† , Hussam El-Kashlan*
  • *Department of Otolaryngology, University of Michigan Medical Center, Division of Audiology, Ann Arbor, Michigan
  • †Ear, Nose and Throat Associates, P.C., Fort Wayne, Indiana
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Publication History

Publication Date:
14 October 2008 (online)

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Abstract

Facial paralysis is a condition frequently seen in otology and audiology clinics. Its most common etiologies are idiopathic, trauma and infection. This article deals with the pathophysiology of facial paralysis, diagnostic technique and treatment modalities illustrated with case studies. The section on pathophysiology includes a discussion of the classification of nerve injury: neuropraxia that may be associated with a compressional injury, axonotmesis associated with an interruption of the myelin layer and axon and neurotmesis involving a complete transection. Among diagnostic techniques, evoked facial electromyography or electroneuronography and needle EMG are discussed and compared. Needle EMG in particular is useful in cases with complete facial paralysis and an evoked EMG reduction of 90% or more. Among patients with idiopathic facial paralysis approximately 71% recover completely and approximately 16% remain with serious sequelae. In terms of treatment, corticosteroids and antiviral medications may be used. Surgical decompression may be used in selected cases to relieve intraneural pressure.

Keywords:

Facial paralysis - Bell's palsy - electromyography - electroneuronography - evoked EMG - facial nerve - motor unit potential - neuropraxia - axonotmesis - neurotmesis - blink reflex - fibrillation potentials