Aim: This case presents with the typical clinical picture of peripheral paralysis of facial nerve and reveals the recommended therapy.
We present the case of a 46-year-old patient presenting with left facial nerve palsy. The patient reported that the sympthomatology appeared after a walk in a very cold evening.
The clinical picture is characterized by flattening of wrinkles and of the nasolabial fold, by a reduced or no hemiface mobility with saliva drooling from one mouth angle, increased lacrimation of the homolateral eye. The patient also complained difficulty chewing and sensorineural deafness. The forehead muscles were spared.
Then we made a diagnosis Bell’s palsy. The recommended therapy was oral Prednisone 60 mg for 6 days. After the first 6 days, we gradually reduced the cortisone-based therapy. We also administered an antiviral therapy of Valaciclovir 500mg, 3 times a day for 7 days.
Twenty days later, there was the resolution of the symptomatology and the complete functional recovery. Discussion: Bell’s palsy is an idiopathic peripheral facial paralysis. Among the typical etiologic factors, there is a cold environment.
In this case, we talk about the so-called Cold Palsy. Another possible cause is the reactivation of herpes simplex.
It manifests more between 35 and 50 years of age without a clear predisposition for a gender or another.
Unlike forms of central origin, in which the muscles of the forehead are spared as the upper facial muscles have a bilateral innervation, Bell’s palsy completely affects a hemiface.
In the space of 3 – 7 days, patients develop weakness or paralysis of the muscles on one side of the face: the nasolabial fold and the other wrinkles of the paretic side are flattened, the mouth angle droops, the patient cannot whistle, he cannot wrinkle his forehead from the paretic side, if he smiles or shows his teeth, he stretches the mouth from the safe side.
In complete cases, if the patient tries to close his eyes, the eyelid of the paretic side will stay open and, sometimes, the eyeball rolls upwards (Bell’s phenomenon).
There can also be an alteration of taste and hearing.
Conclusions: In most cases, Bell’s palsy is a benign pathology, with a complete resolution within 3 ? 4 weeks. Having unknown causes, the therapy is empirical. Most of the treated cases respond positively to the administration of corticosteroids and antiviral drugs.
F. Inchingolo 1-4, A. Palladino2, M. Tatullo 2, M. Marrelli 4 , A.M. Inchingolo 3, V. Angelini 2, V. Picciariello 1 , A.L. Valenzano 2, A.D. Inchingolo1, G. Dipalma1-4 1 Department of Odontostomatology and Surgery, University of Bari, Bari, Italy 2 Private Doctor in Dental Sciences 3 Department of Odontostomatology and Surgery, University of Milano, Milano, Italy 4 Department of Maxillofacial Surgery, Calabrodental Srl, Crotone, Italy