16 y/o male with LMN Facial Palsy

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.


Unit 1

Dr. Sravya Kandala
Dr. Navya
Dr. Raheem
Dr. Gnanadha
Dr. Chetana
Dr. Ashfaq

Dr. Charan PGY1
Dr. Vamsi PGY1
Dr. Sushmitha PGY2
Dr. Aditya PGY3
Dr. Praneeth PGY3
Dr. Praveen Naik Ass. Prof.
Dr. RAKESH BISWAS HOD


Here is a case I've seen:
Admission under Unit 1 on 22/02/2021

16 y/o male patient presented with complaints of deviation of mouth since 5 days and inability to close his right eyelid since 5 days.

Patient was apparently asymptomatic 5 days ago and then noticed left sided deviation of the mouth followed by inability to close his right eye completely with a 12 hour difference between the occurrence of these 2 events.

H/o Difficulty in chewing his food.
H/o cold exposure(sleeping outside) since 10 days.
No h/o of fever, cold, sore throat, loss of taste, decreased salivation & lacrimation.
No h/o ear infection, discharge, decreased hearing.
No h/o UL & LL weakness

No significant past history.

No known allergies.

General Examination

Pt. is conscious, coherent and cooperative.

Vitals
BP - 110/60 mm Hg
PR - 84 bpm
RR - 18 cpm
Temp - Afebrile

CVS - S1, S2 +
RS - BAE +

CNS

Cranial Nerve Examination
All cranial nerves are intact except CN VII.

CN VII

Motor Functions

✓Raising of eyebrow absent on Right side.

✓Loss of wrinkles on forehead on Right side

✓Inability to close right eye completely.

✓Deviation of the mouth to Left side.

✓Unable to blow out the cheeks against closed mouth.

✓ Unable to whistle

Sensory Functions
✓No loss of taste sensation (Anterior 2/3rds of the tongue)

Secretory functions
✓Lacrimation - unaffected
✓Salivation - unaffected

Reflexes

Superficial 
Coreal +.    +.   
Conjunctival +.    +.    
Abdominal.  +.   +.
Plantar. Flexor. Flexor

Deep 
Jaw jerk +
       Right. Left
Biceps. 1+. 1+
Triceps 1+. 1+. 
Supinator 1+. 1+.
Knee. 1+. 1+. 
Ankle. 1+. 1+. 

Power 5/5 in all limbs
Tone - Normal

Diagnosis -  House brackmann grade 4 LMN                               Facial palsy.

Treatment
1. Tab. Zincovit
2. Physiotherapy
3. Eye patch for Right eye to prevent exposure keratitis.

https://bmjopen.bmj.com/content/3/6/e003007#T1


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