September 1997


Arch Otolaryngol Head Neck Surg. 1997;123(9):1010-1014. doi:10.1001/archotol.1997.01900090126021

Imaging Quiz Case 1  Yael Ptachewich, MD; Brian Romaneschi, MD;John K. Niparko, MD; Bronx, NY (Dr Ptachewich), and Baltimore, Md (Drs Romaneschi and Niparko)A 39-year-old woman presented with progressive unilateral facial paralysis that had begun in February 1994. The weakness had begun with impairment of left eye closure and was followed within 1 month by absence of movement in the forehead and lower part of the face. The only accompanying symptom was otalgia of the left ear. The patient reported no hearing loss or vertigo. She was diagnosed as having Bell palsy but failed to have any return of function over the subsequent year, despite treatment trials of steroids and antibiotics. Fifteen months later, the patient demonstrated a persistent grade VI left facial paralysis. High-resolution computed tomography (CT) (Figure 1) and gadolinium-enhanced magnetic resonance imaging (MRI) (Figure 2 and Figure 3) demonstrated parotid gland enlargement and a density involving the geniculate, middle ear, and mastoid segment of the facial nerve. Enlargement of the fallopian canal was seen extending from the meatal foramen

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