OROFACIAL PAIN AND NEUROLOGICAL DISTURBANCES

A healthy female of 30 years is undergoing treatment in restorative department, complained

that her right side of face felt strange. She is not able to close her right eye or smile. Operator
told you before starting treatment he administer inferior alveolar nerve block for treating lower
right second molar.
a. What will be your provisional diagnosis? (1)
b. How will you differentiate lesions of upper and lower motor neurons (5)
c. How will you manage this patient (4)

Answer:
a. Transient facial nerve palsy due to the deposition of a local anaesthetic around the
seventh cranial nerve (facial nerve). The site for inferior alveolar nerve block is in close
proximity to the parotid gland, where the facial nerve divides into its branches.

b.

Upper motor neuron lesion Lower motor neuron lesion

Muscles over mandible and maxilla are Both upper and lower facial muscles are
affected, muscles over forehead are equally affected
unaffected
Lesion is centrally located (pre- petrosal part Lesion is along intra- or extra-petrosal course
of course) of facial nerve
Spastic paralysis occurs Flaccid paralysis occurs

Blink reflex and movement of forehead Blink reflex is lost and movement of forehead
muscles are unaffected muscles is impaired

c. Management:
- As this may be a cause of major concern for the patient, explain to them that this is a
well-understood complication of the local anaesthetic procedure that was used, but
is temporary and should resolve on its own in a day or so.
- Assess the patient’s condition, if they are not under serious distress and are willing
the procedure may be completed. However, if they do not wish to continue, the
procedure should be halted and resumed during another appointment. Any extra
preparation required to ensure no post-operative discomfort occurs should be done.
- Advise the patient to wear eye shades or an eye patch over the affected eye to
prevent any dryness and damage to the cornea.
- Check in with the patient the following day over telephone to make sure that the
paralysis has resolved.
- Finally, details of this incident and follow-up should be written in the patient’s case
notes/file to have proper documentation.