Which states affect the facial nerve


Facial paresis is the paralysis of the muscles that are innervated by the facial nerve, the facial nerve.

The facial nerve is the seventh cranial nerve. He is involved in the following processes, among others:

  • Facial muscle innervation
  • Taste sensation [chorda tympani]
  • Salivary gland secretion: submandibular gland (lower jaw gland) and sublingual gland (sublingual gland) [chorda tympani]
  • Hearing [stapedius nerve]
  • Lacrimal secretion [N. petrosus major]

The pathogenesis is different in depending on the etiology of the disease.

Possible causes of a central facial palsy include intracranial hemorrhage (hemorrhage within the skull; parenchymatous, subarachnoid, sub- and epidural as well as supra- and infratentorial hemorrhage) / intracerebral hemorrhage (ICB; cerebral hemorrhage), an apoplexy (stroke) or a tumor.

In about 60-75% percent of cases one peripheral facial palsy if the cause is not known - one speaks of idiopathic facial nerve palsy, also known as Bell palsy.
Possible causes of peripheral paralysis of the nerve are reactivation of a herpes simplex virus infection (HSV type 1) and cell-mediated autoimmune inflammation.

Etiology (cause) of peripheral facial palsy

Biographical causes

  • Hormonal factors - Pregnancy and the puerperium have a predisposing effect; During pregnancy, the risk of developing idiopathic peripheral facial paralysis is threefold [1]

Disease-related causes

Congenital malformations, deformities and chromosomal abnormalities (Q00-Q99)

  • Möbius nuclear aplasia - congenital disorder which, in addition to facial palsy, leads to further cranial nerve deficits (inheritance: sporadic occurrence)

Certain conditions that originate in the perinatal period (P00-P96)

  • Birth paralysis (injury to the facial nerve) - especially increased risk in forceps delivery (lat. Forceps)

Blood, hematopoietic organs - immune system (D50-D90)

  • Sarcoidosis (synonyms: Boeck's disease; Schaumann-Besnier's disease) - systemic disease of the connective tissue with granuloma formation (skin, lungs and lymph nodes)

Endocrine, nutritional and metabolic diseases (E00-E90)

  • Diabetes mellitus - especially in combination with arterial hypertension (high blood pressure)

Cardiovascular system (I00-I99)

  • Apoplex - lesion of the contralateral cortex or corticobulbar tracts after ischemic infarction
  • Aneurysm (wall bulge) of the vertebral artery (spinal artery)
  • Ischemia-related (due to infarction, bleeding, tumor) - due to an insufficient supply of the nerves with nutrients

Infectious and parasitic diseases (A00-B99)

  • Infections:
    • Herpes simplex virus-1 (HSV-1)
    • Varicella zoster virus (VZV; also varicella zoster virus - if suspected Herpes zoster oticus, whereby reddening, edema (swelling), blistering in the ear area or on the eardrum and an otalgia (pain in the ear region) are indicative
    • Rare viral infections: EBV, CMV, HPV-B19, HIV, enteroviruses, mumps, measles, rubella virus, adeno and influenza viruses
    • Lyme disease (Bacteria from the group of Borrelia (spirochetes))
    • rare bacterial infections: diphtheria (Corynebacterium diphtheriae), ehrlichiosis (bacterium Ehrlichia canis), leptospira, M. pneumoniae, Bartonella henselae, rickettsiae (bacteria of the genus Rickettsia; e.g. Mediterranean region)

Musculoskeletal system and connective tissue (M00-M99)

  • Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis - necrotizing (tissue dying) vasculitis (inflammation of the blood vessels) of the small to medium-sized vessels (small vessel vasculitides), which leads to the formation of granulomas (nodules) in the upper respiratory tract (nose, paranasal sinuses, middle ear, oropharynx) the lower airways (lungs)
  • Sjogren's syndrome (group of sicca syndromes) - autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; Typical secondary diseases or complications of Sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid
    • increased susceptibility to caries due to xerostomia (dry mouth) due to decreased saliva secretion
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic irritation of the throat as well as impaired sexual function due to disruption of the production of mucous glands in the respiratory tract and genital organs

Neoplasms - tumor diseases (C00-D48)

  • Acoustic neuroma (AKN) - benign tumor that originates from the Schwann cells of the vestibular part of the 8th cranial nerve, the auditory and equilibrium nerves (vestibulocochlear nerve), and is located in the cerebellopontine angle or in the internal auditory canal.
    The acoustic neuroma is the most common cerebellar bridge angle tumor. More than 95% of all AKN are one-sided. In contrast, if neurofibromatosis type 2 is present, the acoustic neuroma typically occurs on both sides.
  • Malignant parotid tumors - neoplasms of the parotid gland
  • Meningiomas, glomus tumors - starting from the cerebellopontine angle, often further cranial nerve failures
  • Tumors (neoplasms) on the base of the skull, brain stem or cerebellar bridge angle
  • Tympanic fascial schwannoma (affecting the tympanic cavity (tympanum) or the eardrum (membrana tympani)); Schwannomas (see below) of the facial nerve are rare with an incidence of 0.38%; often affect several segments of the facial nerve

Ears - mastoid process (H60-H95)

  • Cholesteatoma - growth of multilayered keratinizing squamous epithelium into the middle ear with subsequent chronic purulent inflammation
  • Mastoiditis (inflammation of the mastoid process)
  • Otitis media (otitis media)
  • Parotitis (inflammation of the parotid gland)

Psyche - nervous system (F00-F99; G00-G99)

  • Guillain-Barré syndrome (GBS; synonyms: idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two forms: acute inflammatory demyelinating polyneuropathy and chronic inflammatory demyelinating polyneuropathy (disease of the peripheral nervous system); idiopathic polyneuritis (diseases of several nerves) of the spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infection
  • Meningitis (inflammation of the meninges)
  • Multiple sclerosis (MS)
  • Polyneuritis - inflammation of several nerves
  • Progressive bulbar palsy - a disease in which motor nerve nuclei fail and belongs to the group of spinal muscular atrophies (muscle wasting caused by the progressive destruction of motor nerve cells in the anterior horn of the spinal cord)
  • Syringobulbie - disease of the elongated spinal cord associated with its destruction

Pregnancy, childbirth and the puerperium (O00-O99)

  • Pregnancy and the puerperium have a predisposing effect; During pregnancy, the risk of developing idiopathic peripheral facial paralysis is threefold [1]

Injuries, poisoning and other consequences of external causes (S00-T98)

  • Temporal bone fractures
  • Skull base fracture
  • Traumatic brain injury (TBI)
  • Due to trauma - after injuries (in infancy: birth trauma)
  • Poisoning, unspecified

Other causes

  • Idiopathic - a cause is not found (60-80% of cases: idiopathic facial nerve palsy or Bell palsy)
  • After operations on the ear or especially on the parotid gland (parotid gland); After surgical removal of benign parotid tumors (pleomorphic adenomas or Warthin tumors), 40.2% of the patients had facial palsy on the first day after the operation; after two weeks postoperatively 28.3%, after six months 3.9% and after one year 1.6% of the patients [2].

Etiology of central facial palsy

Disease-related causes

Cardiovascular system (I00-I99)

  • Angioma - tumor-like formation of new blood vessels
  • Apoplexy (stroke)
  • Cerebral haemorrhage, unspecified

Neoplasms - tumor diseases (C00-D48)

  • Brain tumors, unspecified

Psyche - nervous system (F00-F99; G00-G99)

  • Pseudobulbar paralysis - a disease caused by a lesion of the corticobulbaric tract (corticonuclearis)


  1. Hellebrand MC et al. (2006) The Mona Lisa Syndrome - the peripheral facial nerve palsy in pregnancy. Z Birth Neonatol 210: 126-134
  2. Ruohoalho J et al .: Complications after surgery for benign parotid gland neoplasms: A prospective cohort study. Head Neck 2016, online April 30; doi: 10.1002 / hed.24496
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