Patient of the month
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Patient of the month PowerPoint PPT Presentation


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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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Patient of the month

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Patient of the month

Patient of the month

Dr. Nourizadeh

Assistant professor of E.N.T


A 52 years old man present to your office with right facial droop

Case problem

A 52- years- old man present to your office with right facial droop


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 examination1

Physical examination


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


Differential diagnosis

Differential diagnosis


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.


Patient of the month

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


Your criteria for nerve decompression

Your criteria for nerve decompression?


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