1. Patient of the month Dr. Nourizadeh Assistant professor of E.N.T

2. Case problem A 52- years- old man present to your office with right facial droop

3. History taking: • Onset & duration • Presence of pain • Presence of skin lesions • Hearing problems • Facial swelling or mass • Prior history of facial palsy • Family history • Past medical history • Past surgical history • Allergy • Social history • Medication • Review of system

4. Physical examination • Well-nourished & Well-developed general appearance • Laterality and extent of facial nerve weakness

5. Physical examination

6. Physical examination • Ear examination was normal. • Eye examination revealed bell’s phenomenon and excessive tearing without chemosis. • Parotid glands was normal. • Neck palpation was normal. • Other cranial nerves was intact. • Skin lesions were not seen.

8. Laboratory tests • Bilateral symmetric high frequency hearing loss • Acoustic reflex was present bilaterally. (Ipsi & Contra) • Lyme test was negative. • Imaging study • EMG/ENOG

9. Differential diagnosis

11. Treatment • Systemic steroid therapy • Antiviral therapy • Corneal protection • Controlling of BS level He returned 7 days after his first visit. His facial nerve function was recovered near completely.

12. Patient regained normal facial function after 4 weeks but 9 months later his facial nerve became paralyzed again. • Ipsilateral facial nerve palsy • Facial palsy began 8 days before presentation and progressed rapidly over 24 hours. • There was not any edema. • Twisting was not seen.

13. Physical exam revealed complete & total right facial nerve paralysis. • EMG/ENOG • Stapedial reflexes • CT scan • MRI

14. Your criteria for nerve decompression?