A 37-year-old black man who had left-sided facial paralysis was diagnosed with Bell’s palsy and given steroids and acyclovir by another clinician. (I’m not sure of the reason for the acyclovir.

Maybe the clinician thought there was a possibility of some other disorder.) Later, when I examined the patient, he said he felt no better and complained of a dull, achy pressure-type pain on the left side of the face in the area of the ear and the meatus. I diagnosed Bell’s palsy involving cranial nerves VII and VIII and trigeminal neuralgia. Carbamazepine (Tegretol) twice daily brought relief. How common is it to see Bell’s palsy and trigeminal neuralgia together?
—Sophia S. Momand, MD, Rancho Palos Verdes, Calif.

Bell’s palsy and trigeminal neuralgia can coexist, as can Bell’s palsy and other cranial neuropathies. A study examined 51 patients presenting to an ER with facial-nerve paralysis (Arch Intern Med. 2004;164:2383-2385). Four of these patients had additional cranial neuropathies, one of which was contralateral trigeminal neuralgia.

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Interestingly, 13 of these 51 patients had ipsilateral facial sensory deficits without a diagnosis of trigeminal neuralgia. The sensory complaints may have been due to abnormal perception of drooping facial tissues themselves (muscle, skin, etc.).
—Christopher Ruser, MD (101-15)