What is the role of imaging studies in the workup of congenital facial paralysis?

Updated: Jan 07, 2019
  • Author: Alan D Bruns, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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  • Conventional neuroimaging does not usually contribute to the understanding the pathogenic mechanisms of congenital unilateral facial nerve palsy except in the case of a very rare large pontine lesion, [36] mastoid tumor, [37] or internal auditory canal stenosis. [38] However, congenital bilateral facial nerve palsy is usually accompanied by other congenital disorders that can be identified. [39]

  • A CT scan of the temporal bone in both axial and coronal views may be considered in infants with complete paralyses from trauma that do not resolve and, thus, surgery is being considered. A temporal bone fracture or any bony spicules within the facial canal may be demonstrated. Associated anomalies of the external ear, middle ear, inner ear, mandible, and the vertical portion of the facial nerve would suggest a developmental etiology of the paralysis.

  • An MRI study provides better definition of the nerve and the surrounding soft tissue. Aplasia or hypoplasia of the nerve may be apparent; these findings strongly suggest a developmental anomaly. In addition, a hematoma or surrounding soft tissue swelling may be present when the paralysis is associated with trauma. This may be enhanced with a 3D-CISS MRI. [39]

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