16 y/o male with LMN Facial Palsy
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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
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