PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：由腮腺唾液酸结石引起的腮腺炎引起的面瘫是一种罕见的临床现象，在以前的文献中尚未报道。由于其稀有性和复杂的症状学，这种情况可能会带来诊断挑战，特别是如果患者有其他潜在的因素，如面部创伤或双侧前额注射肉毒杆菌。这份病例报告阐明了如此复杂的陈述，旨在提高认识，促进临床医生的及时认可。
方法：一位56岁的男性，有明显的高脂血症病史，复发性腮腺炎继发于腮腺唾液管结石，最近向急诊科进行了双侧额头美容肉毒杆菌素注射，右下面部下垂。这种发作在醒来后约一小时，持续时间为4小时。该患者在四天前还具有最近的地面跌倒的病史，这导致了他的右眉的面部创伤，而在损伤区域没有任何明显的神经功能缺损。彻底的神经系统检查显示整个右脸的感觉和运动缺陷，指示影响面神经的颊和下颌边缘分支的潜在病变（CNVII）。对于下运动神经元病变，考虑了几种鉴别诊断，包括最近秋天的软组织创伤或肿胀，由于已知的腮腺结石而压迫，中风,和复杂的偏头痛。进行了脑部MRI以排除中风，没有重大发现。随后的颈部CT扫描显示右侧Stensen导管阻塞且扩张，鼻石明显较大且向前移位，并有腮腺炎症的证据。最终诊断为继发于唾液管结石的腮腺炎引起的面神经麻痹。患者已出院，后来计划进行手术以去除唾液石，从而解决了他的面瘫。
结论：该病例强调需要一种综合的方法来鉴别诊断面部麻痹的表现。它强调了腮腺唾液管结石的潜在参与，特别是有复发性腮腺炎或面部外伤史的患者。迅速识别这种不常见的陈述可以防止不适当的干预，协助及时进行适当的管理，并显著有助于患者的康复和预防长期并发症。
方法：一位56岁的男性，有明显的高脂血症病史，复发性腮腺炎继发于腮腺唾液管结石，最近向急诊科进行了双侧额头美容肉毒杆菌素注射，右下面部下垂。这种发作在醒来后约一小时，持续时间为4小时。该患者在四天前还具有最近的地面跌倒的病史，这导致了他的右眉的面部创伤，而在损伤区域没有任何明显的神经功能缺损。彻底的神经系统检查显示整个右脸的感觉和运动缺陷，指示影响面神经的颊和下颌边缘分支的潜在病变（CNVII）。对于下运动神经元病变，考虑了几种鉴别诊断，包括最近秋天的软组织创伤或肿胀，由于已知的腮腺结石而压迫，中风,和复杂的偏头痛。进行了脑部MRI以排除中风，没有重大发现。随后的颈部CT扫描显示右侧Stensen导管阻塞且扩张，鼻石明显较大且向前移位，并有腮腺炎症的证据。最终诊断为继发于唾液管结石的腮腺炎引起的面神经麻痹。患者已出院，后来计划进行手术以去除唾液石，从而解决了他的面瘫。
结论：该病例强调需要一种综合的方法来鉴别诊断面部麻痹的表现。它强调了腮腺唾液管结石的潜在参与，特别是有复发性腮腺炎或面部外伤史的患者。迅速识别这种不常见的陈述可以防止不适当的干预，协助及时进行适当的管理，并显著有助于患者的康复和预防长期并发症。
