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Facial Findings 01

Topic: Adult

Created on Saturday, June 6 2009 by jdmiles

Last modified on Monday, June 15 2009.

In the video above, I asked the gentleman shown to blink his eyes repeatedly.
Based on the findings visible here, what is the most likely diagnosis?

A) Bell's Palsy

B) Dermatomyositis

C) Lyme disease

D) A cranial nerve 4 mononeuropathy

E) A cranial nerve 6 mononeuropathy

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This question was created on June 06, 2009 by jdmiles.
This question was last modified on June 15, 2009.

ANSWERS AND EXPLANATIONS

A) Bell's Palsy

This answer is correct.

Bell's palsy is a facial mononeuropathy that has an acute onset. With time, many patients recover well. However, as the fibers of cranial nerve 7 grow back, some end up innervating structures that they did not originally innervate. A common example of this is fibers that originally targeted the orbicularis oculi growing back to innervate the orbicularis oris. That is what happened in this man's case. Consequently, whenever he blinks, you can observe small movements of the left side of his mouth. This phenomenon is an example of a synkinesis.
In the video clip below, the unnecessarily large green arrow points to the area where you can see mouth movement every time this man blinks.

(See References)


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B) Dermatomyositis

This answer is incorrect.

This man has no skin findings suggestive of dermatomyositis. Try again. (See References)


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C) Lyme disease

This answer is incorrect.

This man has no visible findings suggestive of Lyme disease. Try again. (See References)


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D) A cranial nerve 4 mononeuropathy

This answer is incorrect.

There is no indication that this man has a cranial nerve 4 mononeuropathy. Try again. (See References)


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E) A cranial nerve 6 mononeuropathy

This answer is incorrect.

There is no indication that this man has a cranial nerve 6 mononeuropathy. Try again. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2005). Adams and Victor's Principles of Neurology, 8th Edition. McGraw-Hill, New York. (ISBN:007141620X)

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adult
Facial Findings 01
Question ID: 060609125
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 06/06/2009
Modified: 06/15/2009
Estimated Permutations: 1800