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Facial nerve palsy is the most frequently occurring cranial neuropathy reported to affect 1 in 60 people during their lifetime. An important step in examining these patients, is establishing whether the palsy is caused by an upper or lower motor neurone. Of the many potential aetiologies, Bell's palsy is the most frequently occurring lower motor neurone lesion. The prognosis for this is good, with approximately 85% of patients making a full recovery within three weeks. The aims of this article are to review the appropriate anatomy, potential causes of facial nerve palsy and describe a recommended assessment and management strategy for these patients.
CPD/Clinical Relevance: To inform readers of the variety of causes of facial nerve palsy and present the evidence-based management.
Article
Facial nerve palsy is the most frequently reported cranial neuropathy and has a multitude of potential aetiologies. There is a reported incidence in the UK of 20 per 100,000, with 1 in 60 people being affected during their lifetime.1 Improved outcomes are associated with early diagnosis and treatment, however, it is worth noting that, in many cases, investigation fails to yield a diagnosis.2 Given the high incidence of facial palsy, dental practitioners should be aware of how to assess and appropriately manage a facial nerve palsy. Most importantly, dental practitioners may play a significant role in quickly identifying cerebrovascular accidents (stroke) or transient ischaemic attacks (TIA) and urgently referring via 999 for medical attention.
A good understanding of anatomy is essential for interpreting the presenting signs and symptoms. The facial nerve, cranial nerve number VII, develops from the second pharyngeal arch and, as such, supplies motor and sensory innervation to the muscles formed by the second pharyngeal arch (Table 1).
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