cnidae
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Hi doc, I was curious if there have ever been any reported cases of paralysis of the face from DCI or other symptoms occuring in the face or head region.
Paralysis of the Face from DCI?
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Dr Deco
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Dear cnidae:
Stroke-like DCS
I am not aware of anything exactly similar to this. I certainly could imagine that gas bubbles in certain areas of the brain could cause problems in a fashion similar to a blood clot and a stroke. Certainly we know of speech and balance problems and lower body weakness. I would not see why the face would be spared such injury.
Possibly some of the physicians on the Board could add some words on this topic.
Dr Deco :doctor:
Readers, please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm
Stroke-like DCS
I am not aware of anything exactly similar to this. I certainly could imagine that gas bubbles in certain areas of the brain could cause problems in a fashion similar to a blood clot and a stroke. Certainly we know of speech and balance problems and lower body weakness. I would not see why the face would be spared such injury.
Possibly some of the physicians on the Board could add some words on this topic.
Dr Deco :doctor:
Readers, please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm
retnug
Registered
Not neccessarily DCI but a reverse block in the sinuses can cause numbness in the face.
Don;t ask me how I know.
gunter
Don;t ask me how I know.
gunter
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There are several dive-related conditions that can cause varying degrees of paralysis in the facial region, and indeed DCI is among them. Nitrogen is quite soluble in fat, and nerves are surrounded by myelin sheaths largely composed of lipids. If dissolved N2 enters the gas phase inside of these sheaths, they may impose mechanical pressure & irritative action, not to mention that once gas bubbles enter the vasculature they can impede circulation. While I have no data at hand, I do not believe that facial motor & sensory abnormalities secondary to DCI are especially rare.
This clinical picture can also result from facial nerve baroparesis. The facial nerve (cranial nerve VII), which controls nearly all of the facial musculature, traverses the middle ear and a bony structure. When equalization of the middle ear space is inadequate, it can put pressure on this rather delicate nerve causing transient paralysis of that side of the face.
Best regards.
DocVikingo
This clinical picture can also result from facial nerve baroparesis. The facial nerve (cranial nerve VII), which controls nearly all of the facial musculature, traverses the middle ear and a bony structure. When equalization of the middle ear space is inadequate, it can put pressure on this rather delicate nerve causing transient paralysis of that side of the face.
Best regards.
DocVikingo
I would think it could happen, as mentioned by others, either in central nervous system (brainstem) or peripheral nerve (CN VII), as in Bell's palsy. To distinguish, you'd check whether there is paralysis/weakness of the forehead/orbicularis oculis (squeezing eye shut) on the affected side. Peripheral nerve problem would cause weakness, but because of crossover from the other side in CNS, that area is usually spared in CNS lesions. As for numbness, that's less clear. Facial skin sensation is from the trigeminal nerve (CN V), but the 7th does have sensory function, and every patient I've seen with Bell's palsy describes a sensory prodrome (dysesthesias/numbness) before the weakness, and they locate it to the ear and cheek area.
Of course if you think it's related to DCI, you'd treat it the same.
As for a middle ear squeeze causing problems, I'll defer to DocVikingo. I've seen lots of divers with squeezes, but never facial weakness, thank goodness.
Of course if you think it's related to DCI, you'd treat it the same.
As for a middle ear squeeze causing problems, I'll defer to DocVikingo. I've seen lots of divers with squeezes, but never facial weakness, thank goodness.
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Interesting discussion of Bell's palsy.
Of course, the sensory function of the facial nerve is quite limited relative to that of the trigeminal & to its own motor distribution.
Best regards.
DocVikingo
Of course, the sensory function of the facial nerve is quite limited relative to that of the trigeminal & to its own motor distribution.
Best regards.
DocVikingo
Laurence Stein DDS
Medical Moderator
Hi Doc Deco, Docvikingo and kelpdiver,
I'm in agreement with all of you. I have my 2 cents to add however.
The facial nerve (CR VII) is a rather complicated nerve. It arises from the base of the scull near the medulla. There it splits into several parts.
Part of the nerve is a motor nerve meaning that it is responsible for motor function for muscles of the face, tongue and salivary glands. Another part is Sensory. This part is called the Chorda Tympani. It is found running along the inside aspect of the tympanic membrane (eardrum).
The corda tympani is resonsible for most of the taste sensation recieved by the tongue. Innervation of the submandibular, and sublingual salivary glands.
The main portion of the nerve supplys muscle innervation and muscle tone to the facial muscles. It this portion is injured, a Bell's Palsy can be produced.
Sensory innervation to most of the parts of the face supplied with motor innervation by CRVII is by the trigeminal nerve (CR V). This nerve supplies feeling to the upper lip, cheeks, lower eyelid, teeth, maxillary sinuses, the hard palate. This portion of the facial nerve penetrates and then exits through the parotid salivary gland under the cheek bone and then traverses the face
During a sinus barotrauma, it is possible for the infraorbital nerve within the infraorbital canal to compressed by the sinus pressure and a loss of sensation will be noted over its distribution. This condition is usually self limiting and goes away. NO FACIAL PARALYSIS
should occur if the infra orbital nerve is involved. However the face supplied by the injured nerve will feel numb. No drooping of the face should be evident.
The facial nerve, on the otherhand, if injured, will cause loss of motor function to a variety of facial muscles. Paralysis may be noted and drooping of facial features on the affected side may be noted.
Viruses, trauma, surgery, insect bite, etc can cause this to happen. If there is a noticable loss in the ability to taste, then chorda tympani should be suspected
In addition, the facial nerve often follow a portion of the Vagus nerve (CR X). The facial nerve also come out of the scull in the area of the acoutic nerve and the ocular motor nerve and the abducens nerve. It would be wise to have the possiblility of an acoustic neuroma checked in that event. Especially if there are visual signs, hearing problems or bells palsy.
Finally, if no external reason for neurologic changes can be found, then a more central lesion may be possible (inside the scull).
For what it's worth, I had to do 4 chamber dives last year because of double vision nearly 72 hours after diving. It pushed the limits of what would possibly been a dive accident. The treatments did nothing to resolve the problem, no stroke or brain lesion was found nor was there and acoustic neuroma.
I'm not so sure sure it was a dive accident but I didn't want to take a chance and had DAN insurance (bless them). The double vision resolved spontaneously in 3 weeks.
Who ever the electrician was on the day the facial nerve was wired, must have been having a really bad day. It goes everywhere and does lots of different things.
OK Doc, and Kelpdiver...how'd I do? Ya know for a dentist who normally just drills and fills?
Regards,
Larry Stein=-)
I'm in agreement with all of you. I have my 2 cents to add however.
The facial nerve (CR VII) is a rather complicated nerve. It arises from the base of the scull near the medulla. There it splits into several parts.
Part of the nerve is a motor nerve meaning that it is responsible for motor function for muscles of the face, tongue and salivary glands. Another part is Sensory. This part is called the Chorda Tympani. It is found running along the inside aspect of the tympanic membrane (eardrum).
The corda tympani is resonsible for most of the taste sensation recieved by the tongue. Innervation of the submandibular, and sublingual salivary glands.
The main portion of the nerve supplys muscle innervation and muscle tone to the facial muscles. It this portion is injured, a Bell's Palsy can be produced.
Sensory innervation to most of the parts of the face supplied with motor innervation by CRVII is by the trigeminal nerve (CR V). This nerve supplies feeling to the upper lip, cheeks, lower eyelid, teeth, maxillary sinuses, the hard palate. This portion of the facial nerve penetrates and then exits through the parotid salivary gland under the cheek bone and then traverses the face
During a sinus barotrauma, it is possible for the infraorbital nerve within the infraorbital canal to compressed by the sinus pressure and a loss of sensation will be noted over its distribution. This condition is usually self limiting and goes away. NO FACIAL PARALYSIS
should occur if the infra orbital nerve is involved. However the face supplied by the injured nerve will feel numb. No drooping of the face should be evident.
The facial nerve, on the otherhand, if injured, will cause loss of motor function to a variety of facial muscles. Paralysis may be noted and drooping of facial features on the affected side may be noted.
Viruses, trauma, surgery, insect bite, etc can cause this to happen. If there is a noticable loss in the ability to taste, then chorda tympani should be suspected
In addition, the facial nerve often follow a portion of the Vagus nerve (CR X). The facial nerve also come out of the scull in the area of the acoutic nerve and the ocular motor nerve and the abducens nerve. It would be wise to have the possiblility of an acoustic neuroma checked in that event. Especially if there are visual signs, hearing problems or bells palsy.
Finally, if no external reason for neurologic changes can be found, then a more central lesion may be possible (inside the scull).
For what it's worth, I had to do 4 chamber dives last year because of double vision nearly 72 hours after diving. It pushed the limits of what would possibly been a dive accident. The treatments did nothing to resolve the problem, no stroke or brain lesion was found nor was there and acoustic neuroma.
I'm not so sure sure it was a dive accident but I didn't want to take a chance and had DAN insurance (bless them). The double vision resolved spontaneously in 3 weeks.
Who ever the electrician was on the day the facial nerve was wired, must have been having a really bad day. It goes everywhere and does lots of different things.
OK Doc, and Kelpdiver...how'd I do? Ya know for a dentist who normally just drills and fills?
Regards,
Larry Stein=-)
You don't need that handwarmer if you can tap out discussions like that! Thanks. I vaguely remember my gross anatomy course (in '76), but I do recall that head and neck made renal physiology look simple. And I can recall that riddle about what the corda tympanae and something else have in common...best left unanswered in public (well, actually you answered it already).
At least you answered gunther's question about sinus barotrauma and facial numbness.
No quick answers to the diplopia. Could it be isolated to any one cranial nerve? If the 7th is susceptible to DCI, I'd think the 6th would be equally or more likely. Certainly it seems to be the most commonly affected by "spontaneous" injury in diabetics, presumably on a vascular basis. I would have been a bit freaked by that...glad you recovered!
At least you answered gunther's question about sinus barotrauma and facial numbness.
No quick answers to the diplopia. Could it be isolated to any one cranial nerve? If the 7th is susceptible to DCI, I'd think the 6th would be equally or more likely. Certainly it seems to be the most commonly affected by "spontaneous" injury in diabetics, presumably on a vascular basis. I would have been a bit freaked by that...glad you recovered!
Larry: not only do you write a wicked posting... but you obviously have a sense of humor... I love "that scene" in Little Shop of Horrors... Think Steve Martin should have won an oscar for it!
Thanks for the great info.
Thanks for the great info.
This exact thing happend to me in my pool sessions during lessons. Thanks for explaining it so well. I was a bit concerned when it happened, one side of my face was pins and needles and I felt a little weird. Went away in about 45 min. to an hour.
Hey, I am a former dental assistant, need help?
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