1. PARALISIA FACIAL PERIFÉRICA
Prof. Dr. Ricardo F. Bento
Professor Titular de Otorrinolaringologia
Faculdade de Medicina da U.S.P.

2. VII PAR CRANIANO
NERVO MISTO - 80% motor
Funções fisiológicas

5. Fisiopatologia

6. Fisiopatologia da lesão
NEUROPRAXIA
AXONIOTMESE
NEUROTMESE
The temporal bone because of it’s particularities and complexity presents one rich pathophysiology that it’s very important in the knowledge of the diagnosis and treatment of the lesions

7. DIAGNÓSTICO Paralisia Central/Periférica Etiologia Topodiagnóstico
Grau de Lesão do Nervo

8. Anamnese/ Exame físico

9. Topodiagnóstico

10. Exames Audiológicos
Audiometria Tonal
Impedânciometria

11. Electroneurography

13. Classificação IDIOPÁTICAS TRAUMÁTICAS INFECCIOSAS TUMORAIS METABÓLICAS
CONGÊNITAS
VASCULARES
TÓXICAS

14. Idiopáticas
Paralisia de Bell
Síndrome de Melkerson-Rosenthal

16. TRATAMENTO Clínico: De 0 a 5 dias- Aciclovir: 30 mg/kg/d (3x/dia)
Dexametazona: 8 mg/dia
Fisioterapia
Descompressão Cirúrgica

17. Traumáticas Fraturas Projéteis de arma de fogo
Ferimentos Cortocontusos
Traumas de Parto
Iatrogênicas

18. Fisiopatologia / Fraturas
Fratura Longitudinal ou Extralabiríntica
70 a 80 % das fraturas
Causadas por impactos laterais (temporoparietais)
A onda de fratura rompe a
porção escamosa
As previously said, the temporal bone is rich in vital internal and external structures.
It is a compact bone that presents structures of different density; for example, the labyrinthic block is extremely hard. It contributes to common fracture lines and gunshot routes, as we will see ahead.
First, let’s address the fracture mechanism of each type of fracturesd of the petrous bone:
Longitudinal or extralabyrinthic fractures
Amount to 70 to 80% of the fractures.
They are caused by lateral impact (temporoparietal) and the wave of shock that spares the labyrinthic block (owing to its hardness) breaks the vertical squamous portion and the fracture curve follows the anterior cavity wall.

19. FRATURA LONGITUDINAL
There may be three longitudinal fracture lines:

20. Fisiopatologia / Fraturas
Transversal ou Translabiríntica
10 a 20 % das fraturas
Impacto vertical ou occipital
A onda de choque passa pelo foramem jugular extendendo-se anteriormente afetando a face interna do osso petroso.
The transversal or translabyrinthic fractures amount to 10 to 20% of the fractures.
They are caused by occipital or vertex impact,.
The facial nerve is more frequently affected (60% of the cases) at two different levels:

21. FRATURA TRANSVERSAL
The fracture wave causing a shock wave that comes from the occipital base and crosses the jugular foramen, extending anteriorly and exteriorly, and they affect the posterior-internal aspect of the petrous bone, normally rupturing the bone labyrinth at the level of the posterior semicircular canal and the vestibular aqueduct. The inner ear canal and the cochlea can also be damaged if the fracture line is further anteriorly.

22. Lesõs por arma de fogo Fisiopatologia
FIREARM BULLETS
Gunshots are normally very harmful and sometimes mortal, depending on caliber, distance of the gun from the impact site and point of entry.
Bullets at close range, long distance or entering through the external auditory canal and mastoid are less mortal.
If shot from short and middle distance, they are normally fatal if the caliber is 38 or greater.
In addition to facial nerve direct lesions, there are affections on the labyrinthic block and vascular structures.
The most common sites where the fragmented bullets are found are the mastoid tip and the stylomastoid foramen.
The presence of the labyrinth in the center and top of the temporal bone, impeding the bullet's progression in the original direction and causing it to deviate to a more complacent region.
The bullet's impact causes severe bone destruction and the burn lesion causes great loss of nerve tissue that often spreads through the reminiscent nerve.

27. Infecciosas Virais (Síndrome de Ramsay-Hunt)
Bacterianas Inespecíficas (Otites)
Bacterianas Específicas (Lyme, Lues, Tb)

28. Tumores
Intrinsecos
Extrinsecos

29. Congênitas

30. Tratamento Cirúrgico Precoce
Descompressões
Anastomoses do N. facial
Anastomoses com outros nervos
Cross Face

31. ..\..\My Videos\FACIAL\descompressao e fistula leonardo.mpg

35. enxerto

36. Hipoglosso Facial