Facial, head and neck disorders

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Facial, head and neck disorders

Trigeminal neuralgia:
• attacks of brief lancinating pain in distribution of 5th cranial nerve; attacks last from a few seconds to minutes
• pain precipitated by some stimulus (eg talking, chewing)
• common in older persons
• treatment - carbamazepine

Bell’s palsy:
• unilateral facial paralysis of acute onset and unknown cause – any age, but mostly young adults. M>F.
• due to inflammation of facial nerve within stylomastoid foramen
• often awake in morning and is face paralysed – mouth drawn to one side. Pain in ear, mastoid region or angle of jaw common
• most recover completely within a few months – permanent paralysis is rare
• analgesics in early stages if painful

Meniere’s syndrome/disease:
• recurrent attacks of severe giddiness, associated with vomiting, tinnitus and increasing deafness
• M>F. Average age of onset = 49yrs
• due to gross dilation of the endolymph system of inner ear
• usually present with history of progressive deafness and tinnitus and a sudden attack of giddiness – vomiting soon develops. During attack  unstable and staggers. More comfortable to lie on side, with affected side up
• attacks recur at irregular intervals
• treatment during attack – bed rest, sedatives (especially those used for motion sickness, eg Stemetil)
• phenobarbitone for prevention

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