The Clinical Study of Etiopathogenesis & Management of Facial Nerve Palsy

Facial nerve plays a major role in maintaining facial symmetry. Facial nerve dysfunction causes physical, functional and psychological impact on quality of life, so early evaluation and management needed. Various causes of facial palsy are ideopathic (Bell's palsy),infection, trauma, neoplasia, iatrogenic etc. Evaluation of patient with facial palsy includes detailed history, clinical examination ( facial weakness, incomplete eye closure, loss of taste, decreased tear and salivary secretions), otoscopic examination of the ear, audiometry , topodiagnostic tests, imaging like CT scan or MRI to be done if indicated. Depending on the etiology patient require conservative or surgical management. An observational study on etiopathogenesis and management of facial nerve palsy was undertaken in our institute and 30 cases of facial palsy who met our inclusion criteria were enrolled for the study.The common age group with facial nerve palsy is 18-30 years. Deviation of angle of mouth/facial asymmetry was the commonest presenting symptom seen in all the cases of facial palsy(30 cases), followed by inability to close eye (26 cases),inability to puff out cheek(25 cases). Majority of the cases of facial palsy were presented with house brackmann grade IV (19 cases) followed by grade III (06 cases),grade II (05 cases). Co morbidities were seen in 08 cases , 06 cases had diabetes mellitus and 02 cases had diabetes mellitus and hypertension. In majority of the cases of facial palsy 15 cases were of bell's palsy, followed by Infection(9 cases), Trauma (04 cases), neoplasia(02 cases).Majority of cases in infective aetiology were chronic suppurative otitis media (06cases), followed by malignant otitis externa (02 cases).Organism in pus culture and sensitivity showed staphylococcus aureus(03 cases), pseudomonas species (02 cases).All (04 cases) temporal bone fracture had longitudinal fracture. Majority of them were presented with delayed onset facial palsy(03 cases).cases of neoplasia with facial palsy had Cerebellopontine angle tumour(01 case), parotid carcinoma(01 case).All bell's palsy cases showed normal hearing.Conductive hearing loss seen in 12 cases. Mixed hearing loss and sensorineural hearing loss presented in each of the one case.HRCT temporal bone done in cases of infection and trauma .(12 cases)MRI performed in cases of malignant otitis externa(02 cases) and neoplasia(02 cases).Out of total 30 cases of facial nerve palsy 70% cases (21) received medical/conservative management. 08 cases (30%) received surgical management. All cases of bells palsy (15 cases) received medical management (antiviral and steroids).All cases of malignant otitis externa received medical management According to culture and sensitivity.All cases of chronic suppurative otitis media received surgical management regardless of the grade of facial palsy.Cases of Bells palsy and infection recovered to grade I within 6 months after proper management.Cases of trauma recovered after medical/surgical management in 1 year to grade I. cases of neoplasia in which surgical management done not recovered in follow-up visits. Summary Patients presented with facial palsy were clinically evaluated, investigated and managed according to their etiology, various outcome of facial palsy observed and noted.