Cheatography
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Disorders + diagnosis of face + Jaw - CN V & VII
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Sensation of V
Pattern of sensory loss -
1 division = peripheral nerve lesion
>1 division = Root/BS lesion
"onion skin" = BS lesion
Type of sensory loss
Dissociated sensory loss (pain + temperature affected, touch preserved) = BS lesion
Presence of limb motor &/or sensory signs? =
Yes + with cranial nerve palsies = intrinsic BS lesion
Yes + without CN palsies = supratentorial/upper cx lesion
Conditions
Vascular - ischaemia (dorsal/lateral area) |
Neoplastic - benign/malignant |
Demyelination - MS |
Syringobulbia |
Acoustic Neuroma |
Trigeminal neuroma |
Meningitis |
Petrositosis (inflammation of petrous part of temporal bone)- otitis media, osteitis/meningitis - VI affected too |
Skull base |
Nasopharygeal cancer/Mets |
Cavernous sinus |
Involvement of IV, VI, + V1 |
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- Tumour, intracavernous aneurysm, cavernous sinus thrombosis (oedema + pain in the eye +ICP), Tolosa Hunt syndrome |
Conditions affecting VII
Bells Palsy: at stylomastoid foramen |
Ramsay Hunt at geniculate ganglion |
Hemifacial Spasm at exit from BS |
Localising Concepts
Unilateral involvement of the lower face |
Contralateral supranuclear lesion (UMNL) - Vascular, Tumour, Demyelination, Infection |
Unilateral involvement of the upper and lower face + contralateral eye closure |
Ipsilateral nuclear/infranuclear lesion |
Peripheral Nerve Lesion
S&S |
Causes |
Unilateral weaknesss |
Parotid gland lesion |
Usually localised to specific muscle group |
Parotid operations |
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Facial Trauma |
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Haematoma |
Facial Canal
S&S |
Causes |
Unilateral, complete facial weakness |
F# of skull base |
Loss of taste +salivation |
Spread of middle ear infection |
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Bell's palsy - most common |
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Leukaemic deposits |
Internal Auditory Meatus
S&S |
Causes |
Ramsey Hunt Syndrome: |
Herpes Zoster of CN VII + Chorda Tympani |
Vesicular rash on external ear |
LMNL paralysis of facial nerve |
Loss of taste sensation over anterior 2/3 of tongue |
Acoustic tumours/meningioma
S&S |
V,VIII (IX, X, XI) palsy |
Loss of taste, salivation & lacrimation |
Hyperacusis |
Wallenberg syndrome
S&S |
Causes |
Long tract signs |
Dorsal BS lesion @ level of pons - Vascular/ischaemic in origin (PICA) |
Ipsilateral LMNL to face |
Demyelination |
Ipsilateral VI palsy |
MND |
Ipsilateral loss of pain & Temp of face |
Syringobulbia |
Contralateral decrease in touch, position and vibration |
Tumour |
Contralateral decrease in pain and temperature in limbs |
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