CASE STUDY 14 - Charles Smythe

Charles Smythe, 66 years old, arrived at the clinic complaining of pain behind the left ear for the last few days. This morning he woke up with difficulty moving the entire left side of his face. He has a masklike appearance to his face as he talks about his pain. He has a history of type 2 diabetes mellitus, which is controlled by diet, and he has no known complications from this disease. He takes propranolol but does not know why. His medical history is otherwise unremarkable. He is 6 feet tall with a weight of 190 pounds. He exercises regularly by walking several miles each day. Until this recent facial paralysis, Mr. Smythe felt well and had no complaints.
On physical examination, it is noted that Mr. Smythe feels a drawing sensation on the left side. He is unable to close the eye, wrinkle his forehead, smile, whistle, or grimace. His face sags on the left side. His blood pressure and pulse are 146/88 and 92 beats/min, respectively. His hand grips are strong and equal bilaterally. He has no weakness in either of his legs. Based on the history and physical examination, Mr. Smythe is diagnosed with Bell palsy and started on prednisone, 60 mg/day. He is also given analgesics for the pain.

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