Differential diagnosis of facial nerve palsy can be distinguished from these two classifications

For a long time, the method of differential diagnosis of facial nerve paralysis has been the most concerned by patients in clinical practice. Therefore, I will introduce the specific identification methods to you below.

1. Central facial paralysis

It is caused by damage to the contralateral cortical-pontine bundle. Because the upper group of facial muscles are not affected, only the lower group of facial muscles on the opposite side of the lesion are paralyzed, and is often accompanied by hemiplegia on that side.

2. Peripheral facial paralysis

(1) Guillain-Barré syndrome (cranial nerve type): Peripheral facial palsy may occur, but the lesions are often bilateral and are often accompanied by damage to other cranial nerves. The cerebrospinal fluid may show protein (increased) cell (normal or slightly elevated) separation phenomenon.

(2) Pons lesions: Because the motor nucleus of the facial nerve is located in the pons, its fibers bypass the abducens nucleus. Therefore, in addition to peripheral facial paralysis, pontine lesions are often accompanied by damage to adjacent structures within the pons, such as paralysis of the ipsilateral lateral rectus muscle, facial sensory impairment, and paralysis of the contralateral limbs.

(3) Damage to the cerebellopontine angle: The fifth and eighth cranial nerves as well as the cerebellum and medulla oblongata on the same side are often damaged simultaneously. Therefore, in addition to peripheral facial paralysis, there may also be symptoms such as ipsilateral facial sensory disturbance, tinnitus, deafness, dizziness, nystagmus, limb ataxia and contralateral limb paralysis.

(4) Lesions in the vicinity of the facial nerve canal: such as otitis media, mastoiditis, otomastoid surgery, and skull fractures. In addition to peripheral facial paralysis, there may be other corresponding signs and medical history.

(5) Lesions outside the stylomastoid foramen: Since the facial nerve passes through the parotid gland after exiting the stylomastoid foramen to innervate the facial expression muscles, parotid gland inflammation, tumors, and surgery in the jaw, neck, and parotid area can all cause peripheral facial paralysis. However, except for facial paralysis, there is often a history of corresponding diseases and characteristic clinical manifestations, without auditory hypersensitivity and taste disorders.