II. Causes: General

  1. Bell's Palsy is idiopathic
  2. Below are listed other causes of Facial Nerve Paralysis

III. Causes: Common

  1. Peripheral nerve causes (Facial muscle paralysis with forehead affected)
    1. Lyme Disease
    2. Otits Media or Mastoiditis
    3. Ramsay Hunt Syndrome
    4. Autoimmune Polyneuropathy (e.g. Guillain-Barre Syndrome, typically bilateral)
    5. Head or Neck Mass Lesion (e.g. Cholesteatoma)
  2. Central/Supranuclear causes (Facial muscle paralysis with forehead spared)
    1. Cerebral mass lesion (e.g. tumor)
    2. Cerebrovascular Accident (typically with ipsilateral Hemiparesis or Hemiplegia)
    3. Multiple Sclerosis

IV. Causes: Trauma

  1. Cortical injury
  2. Temporal Bone Fracture
  3. Brain Stem injury
  4. Penetrating middle ear injury
  5. Barotrauma
    1. Altitude paralysis
    2. Scuba Diving

VI. Causes: Infection

  1. Malignant Otitis Externa (skull base Osteomyelitis)
  2. Acute or Chronic Otitis Media
    1. Gradenigo's Syndrome (CN V or CN VI)
  3. Mastoiditis
  4. Varicella Zoster Virus (Chicken Pox)
  5. Herpes Zoster Oticus (Ramsey-Hunt Syndrome)
    1. Herpetic Vesicles at auricle and external canal
  6. Influenza Vaccine and Influenza
  7. Lyme Disease
  8. HIV Infection
  9. Parotitis
  10. Meningitis or Encephalitis
  11. Mumps
  12. Mononucleosis
  13. Leprosy
  14. Coxsackievirus infection
  15. Syphilis
  16. Tuberculosis
  17. Botulism
  18. Mucormycosis

VII. Causes: Tumor

  1. Facial Nerve neuroma
  2. Cholesteatoma
  3. Glomus jugulare tumor
  4. Primary Temporal Bone tumors
  5. Meningiomas
  6. Hemangioblastoma
  7. Hemangioma
  8. Pontine glioma
  9. Parotid tumor

VIII. Causes: Birth

  1. See Facial Nerve Injury from Birth Trauma
  2. Trauma (forceps delivery)
  3. Molding
  4. Congenital Facial Palsy
    1. Mobius syndrome
    2. Cardiofacial syndrome

IX. Causes: Toxic

XI. Causes: Iatrogenic

  1. Antitetanus serum
  2. Vaccine treatment for Rabies
  3. Mandibular block anesthesia
  4. Head and neck surgery

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