A diabetic and pregnant patient presents with the above finding with an onset of a day or two. She has trouble closing her eyes. She looks funny when she wrinkles her forehead. Oh, oh, oh!Challenge: What's the diagnosis?
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For Whom the Bell Tolls
This is Bell’s palsy, due to a lesion to the peripheral branches of the facial nerve. The facial nerve provides motor output to the facial muscles, parasympathetic fibers to the lacrimal, submandibular, and sublingual salivary glands, afferent taste fibers for anterior 2/3 tongue, and some somatic afferents. It arises at the pontomedullary junction and courses laterally with the vestibulocochlear nerve to the internal auditory meatus. The facial nerve emerges at the stylomastoid foramen. The five major branches are temporal, zygomatic, buccal, marginal, and cervical. Although most times etiology is unknown, Bell’s palsy has been linked to infection, esp. with herpes simplex and herpes zoster. Presentation is a sudden onset unilateral facial paralysis with eyebrow sagging, inability to close the eye, disappearance of the nasolabial fold, and the mouth drawn to the non-affected side.
Sources: UpToDate; MdChoice.com
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