Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Here is the aetiology of facial nerve palsy.

I- Supra nuclear causes (Upper Motor Neuron Lesion [UMNL]):

• Trauma to head.
• Meningitis, encephalitis, and abscess.
• Brain tumors.
  
• Stroke: Hge, thrombosis, embolism.

II- Peripheral causes (Lower Motor Neuron Lesion [LMNL]):

(A) Intracranial:

1) In pons: Congenital nuclear aplasia, Basal meningitis, Pontine Haemorrage, Pontine tumors, Multiple sclerosis.

2) In CPA: Congenital cholesteatoma, Meningioma, Vestibular schwannoma.

(B) Cranial (intratemporal)

1) Traumatic:

• Birth trauma: forceps delivery.
• Fracture especially transverse type.
• Surgical: mastoidectomy, stapedectomy.

2) Inflammatory:

• Acute otitis media with dehiscence in facial canal.
• Chronic suppurative otitis media, especially cholesteatoma.
• Herpes zoster oticus (Ramsy – Hunt syndrome).
• Malignant otitis externa.

3) Neoplastic:

• Glomus tumor.
• Squamous cell carcinoma of middle ear.
• Aconstic neuroma.

4) Idiopathic:  Bell’s palsy 

The commonest cause.

(C) Extra cranial

1. Trauma: cut wound in parotid or face surgery.
2. Sarcoidosis of the parotid.
3. Tumor: malignant parotid tumors

(D) Miscellaneous

• Polyneuritis (Guillane – Barre Syndrome).
• Diabetes mellitus.
• Lyme disease.
• T.B.
• Milkersson Rosenthal Syndrome.

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