David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Cedars Sinai, Department of Neurology, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA.
BMC Neurol. 2024 Mar 22;24(1):102. doi: 10.1186/s12883-024-03602-6.
Facial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians.
A 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen's duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis.
This case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient's recovery and prevention of long-term complications.
由于腮腺涎石病引起的腮腺炎导致的面瘫是一种不常见的临床现象，之前的文献中并未报道过。由于其罕见性和复杂的症状，特别是如果患者有其他潜在的致病因素，如面部创伤或双侧额部肉毒杆菌注射，如本例患者，这种情况可能会带来诊断上的挑战。本病例报告阐述了这种复杂的表现，旨在提高临床医生的认识并促进及时识别。
一名 56 岁男性，既往有高血脂病史，因腮腺涎石病反复发作性腮腺炎，以及最近双侧额部美容肉毒杆菌注射，因右侧面下部下垂就诊于急诊科。发病时间约在醒来后 1 小时，持续 4 小时。患者还在四天前有过一次平地跌倒的病史，导致右侧眉部面部创伤，但在受伤区域没有明显的神经功能缺损。详细的神经系统检查显示右侧面部的感觉和运动功能均有缺损，提示可能有病变影响面神经（CNVII）的颊支和下颌缘支。对于下运动神经元病变，考虑了多种鉴别诊断，包括最近跌倒引起的软组织创伤或肿胀、已知的腮腺结石压迫、中风和复杂偏头痛。进行了脑部 MRI 以排除中风，结果无明显异常。随后进行的颈部 CT 扫描显示右侧 Stensen 导管阻塞并扩张，明显可见更大且向前移位的涎石和腮腺炎症的证据。最终诊断为腮腺涎石病继发腮腺炎导致的面瘫。患者出院后，随后安排了一项去除涎石的手术，解决了他的面瘫问题。
本病例强调了在面瘫表现的鉴别诊断中需要采取全面的方法。它强调了腮腺涎石病的潜在参与，特别是在有反复发作性腮腺炎或面部创伤病史的患者中。及时识别这种不常见的表现可以避免不必要的干预，有助于及时进行适当的管理，并显著促进患者的康复和预防长期并发症。
