facial nerve Facial Nerve

MEEI-Facial Nerve Find a Disease/Condition | Employment | Contact Us | Site Map | The menu has downgraded. It is at the bottom of this page. home otolaryngology department facial nerve Facial Nerve Disorders Causes of facial nerve problems can include: Bell's Palsy Facial Paralysis After Acoustic Neuroma Removal and Other Skull Base Tumors Facial Palsy from Parotid Tumors Melkersson-Rosenthal Syndrome Facial Paralysis After Head Trauma Lyme Disease and other Inflammatory/ Infectious / Metabolic Conditions Facial Palsy from Birth Genetic Syndromes Birth Trauma Facial Paralysis with Chronic Ear Disease Synkinesis and Facial Spasms Bell's Palsy Bell's palsy is a rapid onset paralysis ofthe facial musculature on one side of the face, without an apparentcause. It ordinarily affects all branches of the nerve, from theforehead to the neck. A viral illness preceding the paralysis, earpain, changes in taste, facial numbness, and tongue numbness arecommonly associated symptoms. The cause of Bell's palsy is uncertain, asits other name, idiopathic facial paralysis, reflects. There isevidence to suggest a viral cause, with most data pointing toinfection with herpes simplex virus (HSV). While it is difficult toprove this cause and effect relationship conclusively, the factthat Bell's palsy appears to respond to antiviral andanti-inflammatory medications further supports the relationshipbetween HSV and Bell's palsy. Treatment Most cases of Bell's palsy resolvespontaneously, with no noticeable change in facial expression seenafter recovery. However, it has been shown that treatment withsteroids can either improve or speed up complete recovery, and itis very frequently prescribed for this condition. It has also beenshown to cause a decrease in Bell's palsy associated pain. Steroidsdo have some potential side effects. Therefore, in patients withother health problems, steroid use may not be indicated. Among thepotential problems are altered blood sugar levels, stomach ulcers,and mood and personality changes. A large study examining whether the antiviral agent, acyclovir,would improve recovery in Bell's palsy, showed that if themedication is begun within three days of the onset of theparalysis, it appears to improve recovery. However, the beneficialeffect does not appear to be dramatic. There is much controversysurrounding the role for antiviral medication in the treatment ofBell's palsy. Since the evidence points to an inflammatoryprocess causing destruction within the nerve, and since the facialnerve travels in a tight bony canal from where it exits the brainto where it enters the face, attempts have been made to open up thebony canal during the acute inflammatory phase of Bell's palsy. Therationale for this approach is that if the nerve gets inflamed, itswells, and swelling inside a tight canal will then choke off theblood vessels to the nerve, and cause additional damage bydepriving the nerve of its blood supply. The surgical procedure toopen the bony canal is called total facial nervedecompression. A multi-institution study using thistreatment showed that a subset of patients with severe Bell's palsydid benefit from decompression surgery, if it was performed soonenough after the onset of the paralysis.However, to perform totalfacial nerve decompression is a serious undertaking, and is notwithout risks and complications, one of which is inadvertent damageto the facial nerve. Therefore, the decision to proceed withdecompressive surgery is one that needs to be made jointly betweenpatient and surgeon, with a full understanding of potential risksand benefits. For recurrent Bell's palsy, or unsatisfactory/ prolonged recovery, see other options in the Facial Nerve Disorders Treatment Options section. Phases of Recovery The recovery from Bell's palsy tends to followone of two pathways. The majority of patients begin recovery withinthree weeks of the onset of paralysis. These patients tend torecover fully and represent approximately 85% of all Bell's palsypatients. This is known as the "rapid recovery" group. A smallerset of patients experiences delayed or incomplete recovery, andrequires additional therapy to improve outcome. This "delayed /partial recovery" group represents roughly 15% ofpatients. Generally, those patients with return of somefacial nerve function by the third week, or who don't experiencecomplete paralysis, tend to follow the rapid recovery pattern,while those who have complete paralysis extending beyond threeweeks tend to follow the delayed recovery pattern. Facial Paralysis After Acoustic Neuroma and Other Skull Base Surgery Sometimes removal of an acoustic neuroma, orother skull base tumor in a similar location, results inpostoperative facial palsy. This is related to manipulation of thefacial nerve during tumor removal. Nerves are extremely sensitiveto any manipulation, and can be either temporarily or permanentlyaltered by any surgical procedure around them. Tumors are sometimes closely associated withthe facial nerve, and may even be adherent to it. The removal oflarger tumors has a higher probability of causing facial nervedysfunction than the removal of smaller tumors. Occasionally,tumors distort the anatomy so that key structures are difficult orimpossible to identify. Sometimes the degree of function of thefacial nerve or recovery ability cannot be determined. The recovery phases that follow differentdegrees of neural injury are outlined below. These can be followedwhen the status of the nerve is known, though occasionally thestatus of the nerve is not known at the conclusion of surgery,making management of the resulting facial palsydifficult. Recovery Phases There are three recognized phases of recovery. Nerve intact, slightly stretched duringtumor removal. Near complete to complete recovery expected over weeks tomonths. Nerve intact, severely stretched duringtumor removal. Partial recovery expected over months to a year. Nerve cut for tumor removal. Grafted - Partial recovery expected over 1-2years. Not grafted - No spontaneous recoveryexpected. Utilize other methods of facial reanimation. Facial Weakness From Parotid Tumors (Before and After Surgery) Facial Weakness Before Parotid Surgery When facial weakness develops in the presence of a parotidgland tumor, it suggests that the tumor is affecting the functionof the nerve. Tumors tumors that affect function are more likely tobe malignant cancers rather than benign growths. For complete malignant tumor removal withpreoperative facial nerve weakness, a portion of the facial nervemay need to be removed. If this is the case, the nerve is usuallyreconstructed to permit regeneration if possible. Facial Weakness After Parotid Surgery When facial nerve function is abnormal followingparotid surgery, it is important to distinguish the cause of theweakness. The most common cause is nerve stretching that occursduring tumor removal. In that situation, complete recovery islikely. The degree of nerve weakness appears at the time ofrecovery. Complete facial paralysis takes longer to recover fromthan mild facial weakness. Occasionally, and more frequently withmalignant parotid tumors, the facial nerve must be cut toadequately remove the entire tumor. Sometimes it is possible toperform a neural graft at the time of surgery, in order to promoteregeneration from the native facial nerve stump. In situationswhere the tumor extends deeply along the nerve or extensively intothe facial musculature, grafting is not feasible, and delayedfacial paralysis management is employed. Melkersson Rosenthal Syndrome Melkersson Rosenthal syndrome is characterized by a triad of symptoms, including relapsing facialparalysis, facial edema, and a fissured tongue. It appears to havea familial inheritance pattern, though the specific mode ofinheritance has not been established. With repeated episodes offacial palsy,recovery can diminish. For this reason, some doctorsfeel that facial nerve decompression is indicated since it appersto decrease the severity of the facial palsy in subsequentepisodes. This approach is generally reserved for severe cases withimpending long term facial dysfunction, rather than for routinecases. Recovery phases from bouts of facial palsycaused by Melkersson Rosenthal syndrome follow a similar timecourse to recovery from Bell's palsy. Later bouts may recover moreslowly and less completely. Facial Paralysis After Head Trauma Facial paralysis that occurs following headtrauma can be due to several different injuries. Most commonly,fractures of the temporal bone through which the facial nervetravels (These are also called Skull BaseFractures.) , lead to either temporary or permanent damage tothe nerve. Less commonly, direct brainstem injury or a strokerelated to the trauma can lead to central nervous systemmalfunction, so that the facial muscles do not work properly, evenif the nerve itself is intact. Temporal Bone Fractures Temporal bone fractures are classified into either longitudinal ortransverse fractures, depending on their position through thebone. Longitudinal Fractures Longitudinal fractures are the more common ofthe two, and account for 80% of all temporal bone fractures. Theseare usually sustained from a blow to the side of the head. It mayrupture the tympanic membrane (ear drum), and can result inbleeding from the ear. In about 20% of these, the facial nerve isinjured in the temporal bone.More commonly the cause of the facialparalysis is from swelling within the bony canal through which thenerve runs. Since there is no room for swelling to occur, the nervegets "squeezed" within the facial canal. The blood supply getschoked, and the nerve malfunctions as a result. If this is the case, the facial muscles aresometimes seen to be working normally immediately after the injury,but become weak in the ensuing several hours to days, as swellingsets in. When a patient is badly injured with head trauma, thehealth care providers are often occupied in managing the lifethreatening injuries in the first hours after any serious accident,and facial nerve function is not noted until the patient isconscious. Measures to decrease swelling, such asadministration of steroids, can hasten recovery. Another approachto relieve the squeezing phenomenon on the nerve is to perform afacial nerve decompression, though some feel this is a largeoperation for a problem likely to resolve on its own. It isimportant to emphasize that in cases of delayed facial nerveweakness, standard management is eye protection and patience.Regeneration falls along a spectrum, and facial nerve recovery cantake months to a year. Transverse Temporal Bone Fractures Transverse fractures comprise 20% of temporalbone fractures, and usually result from a blow to the front or backof the head. These tend to be more severe injuries, since the forcerequired to fracture the temporal bone in its transverse dimensionis greater than that required for a longitudinal fracture. Thepathway for these fractures may be directly through the inner ear(containing the hearing and balance organs), so hearing loss andvertigo are common. The facial nerve canal is also more commonlydisrupted, and there is a 50% incidence of facialparalysis. The immediate occurrence of facial paralysis with a transverse temporal bonefracture, suggests disruption of the nerve, and may be repairedwhen the patient is medically stable. The complicating factor isthat often other life threatening issues exist, and requireattention before the temporal bone fracture is addressed. Moreover,the best assessment of facial function requires a cooperativepatient, and many patients are comatose following head trauma,making this impossible. Patient with transverse temporal bone fracture, attempting to smile. Patient with transverse temporal bone fracture, attempting to grimace. Infectious / Inflammatory / Metabolic Disorders Many infectious and inflammatory processescan change facial nerve function. This occurs either through directeffects on the nerve, or because generalized inflammation causesswelling in the tight bony canal through which the facial nerveruns. This chokes the nerve of its blood supply, and causes it tomalfunction from lack of nutrition. Some diseases affect the facialnerve in well understood ways, and others are poorly understood.Below some of the diseases whose pathophysiologic effects on thefacial nerve are understood. Lyme Disease Lyme disease is a spirochetal infection caused by the organism Borrelia Burgdorferi.It is ordinarily transmitted through a deertick vector, and is recognized by a characteristic "Bull's Eye"lesion at the site of the tick bite. In the acute phase of thedisease, this round red mark with a pale center can appear, thoughin up to 50% of infected individuals the lesion goes unrecognizedor does not develop at all. The second phase of the disease,presenting 3-6 weeks after infection, is characterized by migratingjoint pains, fatigue, generalized weakness, and cranialneuropathies. It is during this phase that facial palsy may occur.It can be an isolated symptom, or occur in conjunction withdysfunction of the other cranial nerves. A blood test for thedetection of Lyme disease is available, and it is treated withantibiotics. Multiple Sclerosis Multiple Sclerosis (MS) is ademyelinating disease in which the sheaths surrounding myelinatedmotor nerves are broken down, preventing them from conductingsignals appropriately. It can affect any motor nerve, including thefacial nerve. It may wax and wane substantially, so that nervefunction fluctuates according to the activity of the disease.During periods of disease remission, neural function often returnsto normal. Diabetes Mellitus Diabetes Mellitus (DM) is a lack of internal control overblood sugar levels, based on failure of the islet cells in thepancreas to produce insulin. Blood sugar levels are critical formaintaining proper homeostasis,* and lack of proper control overthese levels causes many organ systems to develop diseaseprematurely. Among these is the nervous system. Neuropathies arecommon in later stages of DM. The facial nerve, like any othernerve, is susceptible to malfunction on the basis of thisDM-associated neuropathy. Facial Paralysis From Birth There are several causes of congenital facialparalysis. These include genetic problems, in utero problems thatdevelop during pregnancy, or paralysis resulting from trauma atdelivery. It is important to try and identify the cause of theparalysis, since management differs according to etiology. Genetic Syndromes Certain geneticallydetermined syndromes have facial paralysis as a phenotypicfeatures. The best known of these is Mobiius Syndrome, in whichthere is a congenital absence of the facial nerve on both sides.This results in a dense bilateral facial paralysis with nopossibility of spontaneous function of the facialmusculature. Mobiius Syndrome These represent the typical features of Mobiius Syndrome. Goldenhar's Syndrome Goldenhar's Syndrome is a maldevelopment ofthe first and second branchial arches, leading to hemifacial microsomia and facial nerve abnormalities. In some cases, there isevidence pointing to an early in utero problem that contributes to the development of hemifacial microsomia. Birth Trauma When a newborn has completely normal anatomic development, but a facial palsy ispresent at birth, the possibility of birth trauma to the nerve mustbe considered. Cases of facial nerve damage from skull basefractures, from forceps delivery, and from shoulder dystocia have been reported. Injuries arevirtually always crush injuries rather than transection injuries,and the prognosis for spontaneous recovery is good. Facial Paralysis with Chronic Ear Disease Facial nerve dysfunction can be seen inpatients suffering from acute and/or chronic otitis media. Thereare a number of ways that the nerve can be affected. Usually thestate of nerve function and the likelihood of full recovery aredependent on the time of onset of facial nerve symptoms during thecourse of the ear disease, and the facial nerveparalysis. Facial paralysis of sudden onset during anacute ear infection is indicative of an acute inflammation leadingto malfunction. This tends to occur in infants and young children,because infection spreads through small gaps in the bony canalsurrounding the nerve. Ordinarily, prompt treatment of theinfection, including removal of infected material in the middle earvia a temporary hole in the ear drum, will lead to resolution ofthe reversible nerve dysfunction. Facial Paralysis in the Immediate Postoperative Setting Facial paralysis or paresis (partial paralysis) immediatelyfollowing ear surgery can be related to one of several things. The administration of local anesthetic cancause a temporary paralysis, lasting for several hours after theprocedure. Removal of all diseased tissue in the middleear and mastoid surgery necessitates exposing a segment of thefacial nerve in its bony canal. This exposure can result in nerveinflammation which can lead to temporary facial nerve paralysis.This type of injury generally shows recovery within weeks tomonths. It is possible to inadvertently nick orsever the facial nerve during middle ear and mastoid surgery. Thisis characterized by immediate, complete paralysis. If the injurywas unrecognized during the operation, re-exploration fordecompression, assessment of the extent of injury, and possiblerepair or grafting is warranted. Sudden facial paralysis in the setting of chronic ear diseasesuggests compression on the nerve. Pressure on the nerve can occurif the disease involves erosion of bone, as is seen withcholesteatoma. Prompt surgical intervention, with the removal ofdiseased tissue, and nerve decompression may result in fullrecovery of function. Synkinesis, Facial Spasms Synkinesis and facial spasms refer tohyperkinetic facial syndromes, and both involve involuntary musclecontraction. Synkinesis refers to the phenomenon wherebydeliberate movement of one segment of the face results in movementin another segment of the face. The classic example of this is whenintended eye closure results in a turning up of the corner of themouth, and when a spontaneous smile results in unintentional eyeclosure. This occurs following facial nerve damage, when the fibersthat are regenerating are misdirected, ultimately reaching targetmuscles for which they were not intended. Facial spasms refer to involuntary, intermittent or persistentcontractions of the facial musculature. It can involve selectedmuscles (orbicularis oculi in essential blepharospasm, forexample), or the entire hemiface (hemifacial spasm). page updated: 10/06/05 Facial Nerve/Disorders First Consult Research Links Clinical Staff Contact Us Facial Nerve/Treatment Options Need Help with Understanding a Word or Condition? 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Sher skincare company. Sensitive Skin - Acne - Rosacea - Antibiotics - Skin Supplements - Teenage Acne Introduction The Sher System Helen Sher Anita Vukomancic Philosophy The Face Debate Search Contact Us Skin Questionaire At last, a skincare company that loves your skin more than you do. Is clear, healthy skin important to you? The Sher System is unique, it is based on the philosophy that water is the most important and effective element in promoting inner and outer health and beauty. It is said that the Sher family have revolutionised skincare in Britain (Tatler, 1993) with their water based system for men, women and teenagers. Does the world really need another skincare company? we believe it does!. After many years of research and development we have identified that missing link between dermatology and cosmetology We are successful in treating acne and rosacea – research shows that around 30% of people continue to suffer with acne into adult life. Rosacea affects an estimated 45 million people worldwide. We opened in September 1991 with a new attitude, one of total customer care, in a relaxing studio at 30 New Bond Street, in the heart of London. Most of all, we teach our clients how to obtain and maintain clean, healthy, glowing skin like no one else can, for the rest of their lives. Our new DVD/Video will enable everyone, wherever they are in the world, to see our studio, and to observe three different case studies. It is informative, educational and will benefit everyone who wishes to improve the condition of their skin. For information on the Sher products please e-mail: skincare@sher.co.uk Home The Sher System Helen Sher Anita Vukomancic Philosophy The Face Debate Contact Us Skin Questionaire

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Compare Prices and Read Reviews on Lotion/Cream Acne & Blemish Control at Epinions.com Join Epinions | Help | Sign In All Categories Beauty Books Business & Technology Cars & Motorsports Computer Hardware Education Electronics Games Gourmet Health Home & Garden Hotels & Travel Kids & Family Magazines & Newspapers Movies Music Musical Equipment Online Stores & Services Outdoor Gear Personal Finance Pets Restaurants & Gourmet Software Sporting Goods ---------------------------------- Related Deals Home > Wellness & Beauty > Acne & Blemish Control We found 30 results for Lotion/Cream Acne & Blemish Control Refine these results by Type Cleansers (14) Treatments (4) by Brand Avon (2) Clean & Clear (2) Murad (3) view more Search Results Showing 1-15 of 30 items Page 1 2 - View all Next Hide photos Sort by Name or Rating Sort by Price Compare Clean & Clear Oil-Free Dual Action Moisturizer Cleansers · Clean & Clear · Lotion/Cream 50 consumer reviews Compare St. Ives Purifying Clear Pore Cleanser Cleansers · St. Ives · Lotion/Cream 50 consumer reviews Compare Noxzema Original Face Wash Cleansers · Noxzema · Lotion/Cream 107 consumer reviews Compare Clean & Clear Continuous Control Daily Cleanser Cleansers · Clean & Clear · Lotion/Cream 59 consumer reviews Compare Sal Ac Wash Sal Ac · Lotion/Cream 1 consumer review Compare Phisoderm Acne Cleansers · Phisoderm · Lotion/Cream 25 consumer reviews Compare OXY Oil-Free Maximum Strength Acne Wash Cleansers · Oxy Balance · Lotion/Cream 3 consumer reviews Compare Avon Clearskin Deep Pore Cleanser Cleansers · Avon · Lotion/Cream 1 consumer review Compare Murad Acne Complex Kit For Oily Skin Treatments · Murad · Lotion/Cream 1 consumer review Compare Clearasil StayClear Zone Defense Cleanser Cleansers · Clearasil · Lotion/Cream 7 consumer reviews Compare No image available. Avon Clearskin Facial Cleansing Scrub Cleansers · Avon · Lotion/Cream 2 consumer reviews Compare Neutrogena Clear Body Scrub, Salicylic Acid Acne Treatment With Microbeads Cleansers · Neutrogena · Lotion/Cream 3 consumer reviews Compare Neutrogena Pore Refining Cleanser Cleansers · Neutrogena · Lotion/Cream 31 consumer reviews Lowest price: $ 13 Compare Lancome Pur Controle Cleansers · Lancôme · Lotion/Cream 4 consumer reviews Compare Murad Acne Complex Kit For Normal/Combination Skin Treatments · Murad · Lotion/Cream 1 consumer review Showing 1-15 of 30 items Page 1 2 - View all Next Refine these results To refine the 30 results above, select a more specific characteristic that best defines what you are looking for from the list of links below. More Options by Type Cleansers (14) Treatments (4) by Brand Avon (2) Clean & Clear (2) Clearasil (1) Lancôme (1) Murad (3) Neutrogena (1) Noxzema (1) PETERTHOMASROTH (5) Phisoderm (1) Sal Ac (1) St. Ives (1) Featured Resources Acne control Heal & prevent acne blemishes with Proactiv. Over 7 million users. www.proactiv.com Acne Complex Clinically Proven Acne Solution. Real Results in 30 Days, Guaranteed AcneComplex.Murad.com Buy Proactiv Solution Clear Skin Begins with Proactiv Revolutionary Skin Care Treatment www.Acne.com AcnEase Acne Treat The Cause, Not Symptoms. Natural Proven Treatment For Acne. www.AcnEase.com ZENMED Acne Treatment Treat Adult Acne in 3 Easy Steps. Order Today and Receive Free S/H www.ZENMED.com Help | Member Center | Message Boards | Site Rules | User Agreement | Privacy Policy | Site Index About Epinions | Careers | Contact Epinions | Advertising Epinions | DealTime USA | DealTime UK | PriceTool | Shopping.com | Rent.com © 1999-2006 Epinions, Inc. Trademark Notice Epinions.com periodically updates pricing and product information from third-party sources, so some information may be slightly out-of-date. You should confirm all information before relying on it.

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Skincare Basics -- Regimens Facials -- Common Skin Flaws  You are here: About > Style > Beauty > Skincare Style Beauty Essentials Pics! 10 Styles Sure to Cause Curl Envy Make Eyes Look Bigger How to Get a Hairstyle You Won't Hate Best Celebrity Hair Cellulite: Why You Have It & She Doesn't Topics Hairstyle Photo Galleries Hair Trends & Advice Prom Hairstyles Hair Color Winter Beauty Makeup Tricks & Tips Beauty by Age: Teens to 50+ Skincare Perfect Nails Plastic Surgery Hair Removal Best Perfumes Makeovers Buyer's Guide Before You Buy Top Picks Top Ten Fragrances for Her Top Ten Fragrances for Him Top Quick Gifts Under $10.00 Product Reviews Forums Help FREE Newsletter Sign Up Now for the Beauty newsletter! See Online Courses   Search Beauty > Skincare Skincare Basics -- Facials, Regimens, Makeup & More Here you'll find everything you need to know about skincare. Get the basics on skincare regimens, facials (both at-home & pro) and which skincare products are right for you. Subtopics All About Facials (3) Moisturizers (1) Bad Breath (3) Problem Skin (3) Cellulite (1) Soap (2) Cleansers (3) Stretch Marks & Pregnancy (2) Fake Tanners (2) Sunscreen (1) Articles & Resources Sort By : Guide Picks | Alphabetical | Recent How to Make Yourself a Salt Scrub -- Homemade Salt Scrubs How to Make Yourself a Salt Scrub -- Homemade Salt Scrubs How Much Should I Exfoliate? How Much Should I Exfoliate? Every day or once a week? Find out how much you should exfoliate & the best products to use. Loofahs -- Are They Good for You? Loofahs -- Are They Good for You? How to Tell What Skin Type You Have The tell-tale signs you have oily, dry, combination or sensitive skin. Skin Care -- The 4 Basic Skin Care Needs Here's the right way & the wrong way to do your basic skin care. How to cleanse, moisturize, exfoliate & protect skin from sun damage. Drink Eight Glasses of Water a Day -- Is Drinking Water Good for Your Skin? How Water Affects Your Skin Is it true drinking a lot of water keeps your skin healthy & moist? Find out the answer to this frequently asked beauty question. Top 8 Causes of Dark Circles Under the Eyes Black or dark circles under or around the eyes can be caused by many different factors. The following are the most common causes of those unattractive dark circles.   Topic Index | Email to a Friend Our Story | Be a Guide | Advertising Info | Work at About | Site Map | Icons | Help User Agreement | Ethics Policy | Patent Info. | Privacy Policy | Kids' Privacy Policy ©2006 About, Inc., A part of The New York Times Company . All rights reserved. Around About Tips to Losing Weight Guide to Distance Learning How to Travel for Less PHOTOS: Italy PHOTOS: Hybrid Cars What's Hot Prom Hair Miss America 2001 short hairstyle Girl Next Door Easy French Twist Headlines Guide to Moisturizer: 5 'Don't Skip' Spots It's wintertime & if you're like us you're legs are... Teri Hatcher or Mandy Moore? Who wouldn't want to look like these two gorgeous women?... Should You Go Short....Short? If you've ever fllirted with the idea of going super... Give Yourself a Virtual Makeover We stumbled upon this virtual makeover site & loved it....