Extracranial Bell's Palsy: A Case Series

The facial nerve which is the seventh cranial nerve, comprising of motor, sensory and parasympathetic components is responsible for voluntary facial movement, taste to the anterior two-thirds of the tongue; and control of salivary and lacrimal gland secretions. Bell’s palsy obtains its name from Sir Charles Bell, (1774-1842). Sir Charles Bell first described the syndrome along with the anatomy and function of the facial nerve. Bell’s palsy is a common, idiopathic, acute, cranial mononeuropathy, affecting males and females equally. It has a slightly higher incidence in men above 40 years of age and in women younger than 20 years of age. The incidence ranges from 11.5 to 40.2/100,000. Individuals with Diabetes Mellitus, arterial hypertension, immunocompromised patients, patients who have had a viral upper respiratory tract infection; and pregnant woman are at greater risk of Bell’s palsy. We present here two unusual cases of Bell’s palsy. The first case was in a 45 year old lady who presented with grade IV House Beckmann facial nerve palsy. The likely aetiology was local anasthesia injection trauma for removal of 16 impacted molar tooth due to aberrant facial nerve pathway but was unlikely due to the delayed presentation. She was managed with oral corticosteroids, valacyclovir and lubricants to prevent eye dryness. The second case was in a 17 year renal transplant recepient on immnuosuppressants, who presented with painful swelling of parotid gland. MRI revealed parotid necrosis with the swelling extending into the retropharyngeal space. He was managed with injectable antibiotics, valacyclovir and reduction in dose of immunosuppressants. Both cases were managed successfully in our tertiary care centre and were discharged after complete recovery.