Bilateral Facial Paralysis Following Tooth Extraction: Case Report

Abstract

N. fasiyalis is the seventh of the twelfth cranial nerves that controls the face, transmits the sense of taste from the two-third part of the tongue and mouth cavity.
CASE: Patient who is 44years old consulted to the Emergency due to hypokinesia at both side of the face and having difficulty on closing the eyelids.According to patients’ statements, it was learned that the patient had a tooth pulled at right bottom side of chin and four days before consultation he started to experience hypokinesia at chin.There were no other disease in patients history. 
According to neurologic examination the patient was conscious, cooperative, oriented, pupillary isohoric, light reflex was bilateral positive, conjugate eye movements were free in four directions, bilateral eye press-clipping were weak, bilateral eyebrow elevation lost exists, bilateral nasolabial gutter was obscure, no toughness at the back of the neck. Muscle forces were whole valid, cerebellar tests were normal, no ataxia.Patient’s tomography results were normal, and no pathology was observed on MR results. The consultation was done to the neurology clinic.Contrast cranial MR was performed and no pathology was observed.Otorhinolaryngology clinic suggested methylprednisolone with 1 mgr/kg/daily reduced dosage.Eye clinic suggested synthetic tears. Neurology clinic was consulted again an advanced clinic was suggested for the patient and the patient was transferred to a third step advanced clinic for treatment. 
CONCLUSIONDoctor can observe bilateral facial paralyzed and it should be known that there could be several reasons that causing it and when anamnesis is performed an investigation for etiology should be implemented.

Keywords

• Bell Palsy,facial paralysis,, Tooth Eextraction

References

1. Referans1. Bayındır T, Tan M, Selimoğlu R: Diagnostic and Therapeutic Methods in Bell Paralysis ENT-Forum 2011;10(1)www.KBB-Forum.net..2011
2. Referans2. Acarkan T, Nazlıkul H. Paralysis of the Facial Nerve Journal of Complementary Medicine, Regulation and Neural Therapy Volume 9, Number 1 : 2015
3. Referans3. Adour KK. Current concepts in neurology: diagnosis and management of facial paralysis. N Engl J Med. 1982;307:348-51
4. Referans4. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002; 549:4-30.
5. Referans5. Angerer M, Pfadenhauer K, Stöhr M. Prognosis of facial palsy in Borrelia burgdorferi meningopolyradiculoneuritis. J Neurol 1993;240:319-321.
6. Referans6. Burmeister HP, Baltzer PA, Klingner CM, Pantel M, Kaiser WA. Computer und Magnetresonanztomographie des N. facialis. HNO 2010;58:433-442
7. Referans7. Chen N, Zhou M, He L, Zhou D, Li N. Acupuncture for Bell’s palsy. Cochrane Database Syst Rev 2010;8:CD002914
8. Referans8. Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, Chen JM. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA 2009;302:985-93.

9. Referans9. Kohler A, Choffl on M, Sztajzel R, Magistris MR. Cerebrospinal fluid in acute peripheral facial palsy. J Neurol 1999;246:165-169.
10. Referans10. Birkmann C, Bamborschke S, Halber M, Haupt WF. Bell’s palsy: electrodiagnostics are not indicative of cerebrospinal fluid abnormalites. AnnOtol Rhinol Laryngol 2001;110:581-584.
11. Referans11. Dosch M. Neurologie und Neuraltherapie. Freudenstädter Vorträge 1979; 6: 129-44.
12. Referans12. Gilden DH. Bell´s palsy. N Engl J Med 2004;351:1323-1331. Referans13. Heckmann JG, Heckmann SM, Lang CJ, Hummel T. Neurological aspects of taste disorders. Arch Neurol 2003;60:667-671.
13. Referans14. Hellebrand MC, Friebe-Hoff mann, Bender HG, Kojda G, Hoff mann TK. Das Mona-Lisa- Syndrom – die periphere Fazialisparese in der Schwangerschaft . Z Geburtsh Neonatol 2006;210:126-134.
14. Referans15. Hesse S, Werner C, Melzer I, Bardeleben A. Lidbeschwerung mit einem auf das Oberlid geklebten Bleiplätchen zur vorübergehenden Therapie des Lagophthalmus. Akt Neurol 2010;37:341-343.
15. Referans16. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-147.
16. Referans17. Mamoli B. Zur Prognoseerstellung peripherer Fazialisparesen unter besonderer Berücksichtigung der Elektroneurographie. Wien Klin Wochenschr 1976;53:3-28.
17. Referans18. Türk Börü Ü. Facial palsy BARNAT (Complemantary Medicine and Neural Therapy Journal) 3/ September/2007
18. Referans19. Sowmya GV, Manjunatha BS, Saurabh G, Mohit Pal S,, Madhusudan A.Facial Pain Followed with Unilateral Facial Palsy: A Case Report with Literature Review. Journal of Clinical and Diagnostic Research. 2014 Aug, Vol-8(8): ZD34-ZD35
19. Referans20. Owsley D, Goldsmith JP. Bell's palsy following primary tooth extraction. A case report. N Y State Dent J. 2012 Apr;78(3):32-3.
20. Referans21. Kutluhan et al. Bilateral Facial Palsy Developed by 3-year Interval in Bilateral Chronic Otitis Media: A Case Report Van Medical Journal, Volume: 8, No: 1, January/2001:32-35
21. Referans22. Akdag et al. A rare cause for bilateral and repetitive facial palsy: Melkersson-Rosenthal syndrome. Dicle Med J Vol 42, No 1, 102-106