Download Facial Nerve Lesion

Facial Nerve Lesion- An Algorithm
Author: Peter Turton
Questions to ask yourself:
Are the upper facial muscles
spared?
Eg. does the patient have problems
closing his/her eyes?
Is the weakness on both sides?
Yes
Consider a
CONTRALATERAL,
SUPRANUCLEAR lesion.
(UMN)
Consider:
Bilateral Pontine lesions
Bilateral infranuclear
lesions
Muscle disease
Is there unilateral, weakness with
problems in eye closure? (LMN)
Consider ipsilateral
nuclear/infranuclear lesions
Is there or problem with eye
abduction? OR
Is there contralateral limb weakness
Medial pons with possible
VI nerve involvement
Is the facial sensory loss or palsies
of the VIII, IX X, XI nerves?
Cerebellopontine lesion
with possible trigeminal
nerve involvement
Is there a positive Schirmer’s test,
or does the history indicate dry
eyes, or loss of taste?
Consider an internal
auditory canal lesion with
possible geniculate ganglion
involvement
Is lacrimation intact, but taste and
salivation impaired?
Consider a facial canal
lesion, distal to geniculate
ganglion
Does the history indicate an acute
onset, or facial pain preceding
weakness?
Does the history indicate facial
trauma?
Does the weakness affect a
specific muscle group?
Consider Bell’s palsy
Consider a stylomastoid
foramen lesion
Consider a peripheral nerve
or parotid gland lesion
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