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Patient of the month. Dr. Nourizadeh Assistant professor of E.N.T. Case problem. A 52- years- old man present to your office with right facial droop. History taking:. Onset & duration Presence of pain Presence of skin lesions Hearing problems Facial swelling or mass

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Presentation Transcript
patient of the month

Patient of the month

Dr. Nourizadeh

Assistant professor of E.N.T

history taking
History taking:
  • Onset & duration
  • Presence of pain
  • Presence of skin lesions
  • Hearing problems
  • Facial swelling or mass
  • Prior history of facial palsy
  • Family history
  • Past medical history
  • Past surgical history
  • Allergy
  • Social history
  • Medication
  • Review of system
physical examination
Physical examination
  • Well-nourished & Well-developed general appearance
  • Laterality and extent of facial nerve weakness
physical examination2
Physical examination
  • Ear examination was normal.
  • Eye examination revealed bell’s phenomenon and excessive tearing without chemosis.
  • Parotid glands was normal.
  • Neck palpation was normal.
  • Other cranial nerves was intact.
  • Skin lesions were not seen.
laboratory tests
Laboratory tests
  • Bilateral symmetric high frequency hearing loss
  • Acoustic reflex was present bilaterally. (Ipsi & Contra)
  • Lyme test was negative.
  • Imaging study
  • EMG/ENOG
treatment
Treatment
  • Systemic steroid therapy
  • Antiviral therapy
  • Corneal protection
  • Controlling of BS level

He returned 7 days after his first visit. His facial nerve function was recovered near completely.

slide12
Patient regained normal facial function after 4 weeks but 9 months later his facial nerve became paralyzed again.
  • Ipsilateral facial nerve palsy
  • Facial palsy began 8 days before presentation and progressed rapidly over 24 hours.
  • There was not any edema.
  • Twisting was not seen.
physical exam revealed complete total right facial nerve paralysis
Physical exam revealed complete & total right facial nerve paralysis.
  • EMG/ENOG
  • Stapedial reflexes
  • CT scan
  • MRI
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