Facial Nerve Consultation

Introduction

Facial paralysis and its sequela is a complex medical issue that can be both physically and emotionally distressing. Patients may present to us at any time along the continuum of their recovery or lack of recovery. In addition to the medical aspects of treatment, psychosocial impacts are common and must also be addressed. Here we discuss our approach to the evaluation and early management of patients with facial nerve dysfunction.

History

Upon initial evaluation for facial nerve dysfunction, there are a few key components of the history that are invaluable in diagnosing and ultimately guiding management. First, a timeline of the onset of facial paralysis is essential. It is important to understand if the paralysis occurred immediately or over the course of a few days or months. This needs to be followed up with further questioning about the severity of the weakness, to include partial or complete paralysis. If some time has passed since the onset of facial paralysis, a timeline of recovery is also needed. Certain etiologies, such as Bell’s palsy, are supported by recovery of facial function within 2 to 3 months. Failure to recover function within that period may indicate a different etiology and further workup with imaging and nerve conduction studies may need to be initiated.

The health care provider should also ask specific questions that might indicate more clearly the etiology of the dysfunction. Common causes are inflammatory post viral, neoplasms, trauma, congenital, and infection including otologic pathology. ^, Questions for diagnostic purposes can include personal history of past facial paralysis, family history, presence of vesicles or rashes, travel history, or recent surgery or trauma. The practitioner should also note other symptoms temporally associated with onset of facial paralysis such as hearing loss, dizziness, facial pain, facial twitching, or facial swelling.

The next part of the history should discern if the patient has received any prior treatments for their paralysis such as steroids or antivirals. Some patients may have participated in facial exercises or electrical stimulation to aid in their recovery. ^{, ,} Questions regarding past imaging are necessary and may direct further workup. In the setting of tumor extirpation or oncologic causes of facial paralysis, radiation therapy may have been performed or may be planned in the future.

As each patient has a unique perception of their facial deficit, it is imperative to ask each patient to articulate what is most bothersome to them, as this may not always correlate to the most notable deformity to the clinician. Patient-driven care can be appropriate, especially in the partially recovered facial paresis or synkinetic patient.