An Unusual Case of Bell’s Palsy After Removal of Impacted Third Molars

Abstract

Background and Overview: Bell’s Palsy is a rare complication of third molar surgery which can be alarming both for the patient and the surgeon. Case Description: The patient was a 21-year-old female who presented for routine extractions of 1, 17 and 32 under IV sedation. The procedure was performed without complications. She reported back to the clinic two days later with a chief complaint of inability to close her left eye. On examination it was found that she had profound weakness of the front and zygomatic branches of the left facial nerve consistent with Bell’s Palsy. The patient was treated with steroids, antivirals and eye protection. The patient had full recovery of nerve function in approximately four weeks and suffered no complications. Conclusion and Practical Implications: Bell’s Palsy is a rare complication of facial surgery and can afflict patients undergoing third molar extraction. The stress of surgery can lead to viral reactivation, causing swelling of the facial nerve as it course through the petrous portion of the temporal bone. Though rare, patients should be warned of the possibility of Bell’s Palsy in the preoperative period. Patients who suffer from Bell’s Palsy need to be reassured, given appropriate eye protection to include eye lubricant and eye patches and should be instructed on how to care for their eye while sleeping through taping. The literature supports the use of steroid therapy while the usefulness of antiviral medication remains controversial.