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Facial nerve palsy has specific symptomology, but varied aetiology. Prompt and thorough assessment is required to ascertain if upper or lower motor neurone damage has occurred. This report discusses a 6-year-old female, presenting in the Emergency Department with unilateral facial weakness. Initially thought to be facial swelling relating to her carious dentition, clinical assessment from the maxillofacial team identified that the patient had a unilateral facial palsy, later diagnosed as Bell's palsy. Her delayed presentation was due to initial misdiagnoses in primary care. This case report aims to highlight its aetiology, clinical features and appropriate management.
CPD/Clinical Relevance: To make the general dental practitioner aware of different causes of facial paralysis, and to provide GDPs with an algorithm to follow in the presentation of a facial palsy in the primary care setting.
Article
The most common cause of facial nerve paralysis is Bell's palsy, often thought to be the result of herpes simplex or herpes zoster virus activation.1,2 Statistically, it is most prevalent in patients aged between 15 and 45, and is often diagnosed after the exclusion of more serious causes of facial paralysis.2 Dental abscesses are relatively common causes of facial swellings. When dental pulp is breached, as a result of carious processes, or trauma to the dentition,3 it becomes infected and necrotic. Anaerobic bacterial organisms begin to colonize these tissues. Eventually, polymicrobial biofilms, and their harmful metabolic waste products, escape into the periapical tissues, causing dental abscess formation, which can track within the soft tissue spaces of the neck, resulting in facial swellings.
A 6-year-old female presented in the Emergency Department at Nottingham Queen's Medical Centre (QMC). Her mother reported a 2-week history of a persistent left facial swelling, which started as toothache from the upper left quadrant. During this time frame, initial management was provided through her GP, who prescribed a course of amoxicillin, and her GDP, who advised tooth extractions of the carious deciduous dentition. Upon completion of the antibiotics, the facial swelling remained unchanged. It was this presentation that prompted their attendance at the QMC.
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