facial nerve palsy

Upper vs Lower Motor Neurone Lesion

Each side of the forehead has upper motor neurone innervation by both sides of the brain
Each side of the forehead only has lower motor neurone innervation from one side of the brain
In an upper motor neurone lesion (stroke, tumour), the forehead will be spared and the patient can move their forehead on the affected side
In a lower motor neurone lesion (Bell’s palsy, Ramsay-Hunt), the forehead will NOT be spared and the patient cannot move their forehead on the affected side

Idiopathic
Viral infections, particularly reactivation of herpes simplex virus type 1 (HSV-1), have been implicated as a possible cause

If patients present within 72 hours of developing symptoms - prednisolone
Antiviral plus steroids may offer a small benefit - discuss with a specialist
Lubricating eye drops ******to prevent the eye on the affected drying out and being damaged
The majority of patients fully recover over several weeks but recovery may take up to 12 months