One thought on “December 2018 PDF

  1. Love the emojis for lower motor neurone palsies of the facial nerve.

    Still within lower motor neurone presentations, it is worth pointing out that the nerve to stapedius comes off the facial nerve in the middle ear. A palsy of this branch causes hyperacusis (echoing sound). Bell’s palsy is idiopathic facial nerve palsy of the facial nerve as it exits the skull base at the stylomastoid foramen. This is after the branch to stapedius has come off so hyperacusis should NOT be present in a Bell’s palsy.😜👂📣

    Other middle ear branches of the facial nerve are the chorda tympani and the greater superficial petrosal nerve which provide parasympathetic innervation to facilitate taste, salivation and tear production. When this goes wrong you get crocodile tears i.e. Crying when you should salivate. So, like hyperacusis, this is a feature of proximal lower motor neurone facial nerve injury, and not Bell’s palsy. 🐊😢😪😭🤤

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