R. NICKBRYANMDS. JAMESZINREICHMD
A 5-YEAR-OLD boy presented with a complaint of left-sided facial weakness. His parents reported a history of slowly progressive facial asymmetry that had begun when he was approximately 1 year old. A magnetic resonance imaging scan of the brain had been performed at the request of the referring physician and was reported to show no abnormalities.
Physical examination revealed very slight forehead movement, mouth asymmetry with maximal effort, and the ability to close the left eye only with maximum effort (House-Brackmann grade 3). There were no other neurologic abnormalities, and the findings of the rest of the head and neck examination were normal. The results of initial laboratory assessment, including erythrocyte sedimentation rate; Lyme, antinuclear antibody, and fluorescent treponemal antibody titers; and audiography, were all normal or negative. A computed tomographic scan of the temporal bone was obtained (Figure 1 and Figure 2).
Amir R, Young N. Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2001;127(2):213. doi: