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?