A 51-year-old woman comes to the office because it feels like the right side of her face has been getting heavier for the past 12 hours. Medical history is significant for type 2 diabetes mellitus. Physical examination reveals asymmetry of her face when she smiles, puffs out her cheeks, raises her eyebrows, and tries to close her eyes tightly. There is also effacement of the right nasolabial fold, and her lips are drawn toward the left side. The remainder of the neurologic examination is normal. Which of the following additional findings is most likely associated with this patient's condition?

Question

A 51-year-old woman comes to the office because it feels like the right side of her face has been getting heavier for the past 12 hours.  Medical history is significant for type 2 diabetes mellitus.  Physical examination reveals asymmetry of her face when she smiles, puffs out her cheeks, raises her eyebrows, and tries to close her eyes tightly.  There is also effacement of the right nasolabial fold, and her lips are drawn toward the left side.  The remainder of the neurologic examination is normal.  Which of the following additional findings is most likely associated with this patient's condition?

Quizplus · Accepted Answer

11ec160b_3597_e0e6_9249_8f3da8037873_MD0001_00 This patient's acute hemifacial weakness is consistent with Bell palsy, an idiopathic mononeuropathy affecting the facial nerve (CN VII). CN VII is a mixed nerve, consisting of the following: Patients with Bell palsy typically have a sudden onset (within hours) of unilateral facial paralysis. Specific findings include impaired eye closure; eyebrow sagging; inability to smile, frown, or purse lips on the affected side; disappearance of the nasolabial fold; and lips drawn to the nonaffected side. Patients with Bell palsy may also have decreased tear production, hyperacusis, and/or loss of taste sensation over the anterior two-thirds of the tongue. (Choice A) Trigeminal nerve (CN V) somatic afferents are responsible for providing general sensation over the face; the motor branch of CN V (V₃) innervates the muscles of mastication and the tensor tympani (sound dampening). (Choice C) The levator veli palatini elevates the soft palate during swallowing (and when saying "ah"). Palate elevation is mediated by the pharyngeal branch of the vagus nerve (CN X). (Choice D) Horner syndrome occurs due to interruption of sympathetic innervation and classically presents with hemifacial ptosis, miosis, anhydrosis, and enophthalmos. Postsynaptic sympathetic axons travel in a perivascular plexus along the carotid arteries to reach and innervate the face. (Choice E) Taste sensation from the posterior one-third of the tongue is provided by the glossopharyngeal nerve (CN IX). Educational objective: Because of the diverse functions of the facial nerve (CN VII), patients with Bell palsy may experience decreased tear production, hyperacusis, and/or loss of taste sensation over the anterior two-thirds of the tongue, in addition to unilateral facial weakness.

A 51-Year-Old Woman Comes to the Office Because It Feels