Recurrent Facial Nerve Palsy

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Noon Report today raised the question of recurrent facial nerve palsies. When encountering recurrent facial paralysis the rare disorder of Melkersson-Rosenthal Syndrome is in the differential. Dr. Choi described M-R Syndrome today with the classic triad:

  • recurrent orofacial edema
  • recurrent peripheral facial palsy
  • fissure tongue (lingua plicata)

This may have a correlation to sarcoidosis and Crohn's disease as there is granulomatous inflammation on biopsy. Steroids may be helpful.

As a reminder, when thinking about facial nerve palsy the differential includes:

  • Bell's Palsy: HSV is the most common precipitant and then herpes zoster. It can also be associated with vaccination and pregnancy.
  • Herpes Zoster: check for vesicles and look in the ears (Ramsey-Hunt)
  • Guillan Barre: check for progressive, symmetric muscle weakness and diminished DTRs
  • Lyme Disease: check for rash and tick bites; look for heart block, arthritis and hearing loss
  • Sjogren's Syndrome:
  • Otitis media:
  • Sarcoidosis:
  • HIV:
  • Tumor:
  • Stroke: check if they are able to raise their eyebrows or not to delineate UMN vs. LMN

And remember, while Occam's razor emplores us to find a unifying diagnosis for all symptoms, this may not always be the case. Hickum's dictum reminds us that patients can have any many diagnoses as they choose. So, recurrent facial nerve palsy and new hypoxia may be Melkersson-Rosenthal Syndrome or recurrent idiopathic Bell's Palsy along with heart failure vs. COPD vs. other (?)