Each side of the forehead has upper motor neurone innervation by both sides of the brain
Each side of the forehead only has lower motor neurone innervation from one side of the brain
In an upper motor neurone lesion (stroke, tumour), the forehead will be spared and the patient can move their forehead on the affected side
In a lower motor neurone lesion (Bell’s palsy, Ramsay-Hunt), the forehead will NOT be spared and the patient cannot move their forehead on the affected side
Bell’s palsy
Aetiology
Idiopathic
Clinical presentation
Unilateral lower motor neurone facial nerve palsy
Management
If patients present within 72 hours of developing symptoms - prednisolone
Antiviral plus steroids may offer a small benefit - discuss with a specialist
Lubricating eye dropsto prevent the eye on the affected drying out and being damaged
The majority of patients fully recover over several weeks but recovery may take up to 12 months
Ramsay-Hunt Syndrome
Aetiology
Varicella zoster virus (VZV)
Clinical presentation
Unilateral lower motor neurone facial nerve palsy
Patients stereotypically have a painful and tender vesicular rash in the ear canal, pinna and around the ear on the affected side
This rash can extend to the anterior 2/3 of the tongue and hard palate
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