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July 2018Background
Unilateral facial nerve paralysis can have numerous causes, but most cases are attributed to Bell’s palsy, a seemingly idiopathic, rapid-onset unilateral paralysis (usually occurring within 72 hours), with up to 90% of patients recovering spontaneously within 12 weeks. In the management of facial paralysis due to trauma, infection, or neoplastic origin, making a timely diagnosis is crucial for addressing the underlying cause, with a possible secondary goal of restoring nerve function. Patients presenting with a unilateral facial paralysis most frequently are evaluated in the primary care or emergency setting, and misdiagnosis of presumed Bell’s palsy is common. Although Bell’s palsy has a classic presentation readily identified with a thorough history and physical exam, it remains a diagnosis of exclusion after other potential causes are ruled out.
Imaging has been described as a sensitive method for distinguishing among etiologies of unilateral facial paralysis. Specifically, gadolinium-enhanced magnetic resonance imaging (MRI) is the modality of choice for lesions located within the parotid gland, cerebellopontine angle, and internal auditory canal (IAC), whereas high-resolution computed tomography (CT) is preferred for temporal bone pathology.
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