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 VPattern 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 ConditionsVascular - 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 | | | - Tumour, intracavernous aneurysm, cavernous sinus thrombosis (oedema + pain in the eye +ICP), Tolosa Hunt syndrome |
Conditions affecting VIIBells Palsy: at stylomastoid foramen | Ramsay Hunt at geniculate ganglion | Hemifacial Spasm at exit from BS |
Localising ConceptsUnilateral 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 LesionS&S | Causes | Unilateral weaknesss | Parotid gland lesion | Usually localised to specific muscle group | Parotid operations | | | Facial Trauma | | | Haematoma |
Facial CanalS&S | Causes | Unilateral, complete facial weakness | F# of skull base | Loss of taste +salivation | Spread of middle ear infection | | | Bell's palsy - most common | | | Leukaemic deposits |
Internal Auditory MeatusS&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/meningiomaS&S | V,VIII (IX, X, XI) palsy | Loss of taste, salivation & lacrimation | Hyperacusis |
Wallenberg syndromeS&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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