HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Medical Management of Acute Facial Paralysis

hearing loss may indicate temporal bone trauma. A past medical history of immune disorders or other systemic disorders may be important, especially if associated with a bilateral or recurrent paralysis. The patient’s age at presentation is important. Traumatic congenital FP presents at birth and is noticed with the first cry or grimace. The time course of FP is also impor- tant ( Fig. 1 ) and may point to a diagnosis. BP classically evolves over the first 72 hours

Fig. 1. Natural history of various etiologies of acute FP. ( A ) Graph shows BP with earliest re- covery and return to baseline facial function. Red line depicts a minority of BP, VZV, or Lyme, or post-vestibular schwannoma resection. Note incomplete recovery. Shaded bar shows window of possible surgical decompression between 3 and 14 days. ( B ) Green line shows waxing and waning pattern evident in Melkersson-Rosenthal Syndrome (MRS), geniculate ganglion vascular malformation (GGVM), or other systemic causes. Note progressive loss of facial function over time. Red line shows tumor-related FP with slowly progressive FP. Yellow line shows tumor-related FP with sudden FP and no recovery. ( Courtesy of Tessa A. Hadlock, MD, Boston, MA; Modified by Teresa MO, MD, New York, NY.)

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