Ramsey-Hunt Syndrome

Facial paralysis caused the chicken pox virus (varicella) is called Ramsey-Hunt syndrome. After having had chicken pox sometime during one’s life, the viral particles remain inactive within the nerves. Upon exposure to extremes in temperature, a stressful event or a cold, the viral particles are reactivated. The symptoms include a facial paralysis associated with a characteristic rash around the ear, hearing loss, and/or a balance disorder.

Treatment of the facial paralysis is the same as Bell’s palsy except steroids are not recommended because they can make the viral infection worse. Acyclovoir or its derivatives are used for treatment. Topical acyclovoir ointment can be used on the rash. Typically grouped vesicles filled with fluid eventually burst leaving a scab. Eventually the scabs slough and the skin heals. The hearing loss and/or tinnitus may or may not resolve. The balance disorder usually does get better with time. The same criteria that are used for surgical decompression of the facial nerve for Bell’s palsy also apply to Ramsey-Hunt syndrome.

Facial Paralysis from Middle Ear Infections

When the facial paralysis results from an acute middle ear infection, a myringotomy with insertion of a tympanostomy tube in the eardrum along with antibiotics will usually lead to resolution of the paralysis and the infection. On occasion, tympanomastoid surgery is required.

Cholesteatoma or a growth of skin in the middle ear may also erode the bony covering of the facial nerve and cause a facial paralysis. This usually requires tympanomastoid surgery.

Traumatic Facial Paralysis

The facial nerve can be injured in a number of different ways with trauma to the head and face. Severe head trauma can lead to brain injury which can affect the facial nerve fibers as they course through the brain and brainstem. As mentioned previously, the eyebrow usually functions normally while the rest of the face may be paralyzed. Treatment of the brain injury usually leads to improvement in facial nerve function.

A fracture through the temporal bone, the bone which houses the middle and inner ear, can also fracture the bony canal of the facial nerve. A bony fragment can tear or bruise the facial nerve or compress the nerve to the point where it becomes nonfunctional. This kind of injury may require surgery to either decompress the nerve or repair a lacerated nerve. In a similar fashion, a gunshot wound through the temporal bone can also harm the facial nerve.

Lacerations of the face especially in the region of the parotid gland can divide the main trunk or branches of the facial nerve on its way to the facial muscles. Exploration of the nerve and repair is usually indicated.