Patient of the month
Dr. NourizadehAssistant professor of E.N.T
A 52- years- old man present to
your office with right facial droop
Case problem
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
• Well-nourished & Well-developed general appearance• Laterality and extent of facial nerve weakness
Physical examination
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• Bilateral symmetric high frequency hearing
loss• Acoustic reflex was present bilaterally. (Ipsi &
Contra)• Lyme test was negative.• Imaging study• EMG/ENOG
Differential diagnosis
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 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.
• EMG/ENOG
• Stapedial reflexes
• CT scan
• MRI
Your criteria for nerve decompression?