Paralysie faciale périphérique et soins dentaires : lien ou coïncidence, pour quelle prise en charge ?

Abstract

Résumé -Introduction : L'atteinte du nerf facial est angoissante pour le patient du fait de la déformation faciale qu'elle entraîne et pour le praticien qui se sent impuissant. La survenue d'une paralysie faciale périphérique, suite à des soins dentaires, est rare. Lorsqu'elle survient, aucune notion de traumatisme ou d'étiologie iatrogène ne peut être mise en cause de manière formelle. Observation : Le cas d'une patiente atteinte d'une paralysie faciale périphérique de grade IV selon la classification de House-Brackmann apparue suite à une anesthésie loco-régionale au foramen mandibulaire est décrit. Discussion : La notion de réactivation du virus varicelle-zona suite à un stress quel qu'il soit serait l'origine la plus probable. L'American Association of Neurology recommande la mise en place d'un traitement combiné de prednisolone (1 mg/kg/j) et d'aciclovir (400 mg 5 ×/j) pendant 10 jours ; il est également admis que toute paralysie faciale doit être prise en charge le plus précocement possible, idéalement dans les 72 heures, le succès du traitement dépendant en grande partie de sa rapidité d'instauration. Abstract -Introduction:Any facial nerve injury is a distressing condition for both the patient because of the facial deformity it leads and the practitioner who feels powerless. The occurrence of facial palsy following dental care is rare. When it occurs, any notion of trauma or iatrogenic etiology cannot be questioned formally. Observation: This article focuses on the case of a patient with a grade IV peripheral facial palsy according to House-Brackmann's classification, appeared after regional anesthesia at the mandibular foramen. Discussion: The concept of reactivation of varicella-zoster virus following stress would be the most likely origin. The American Association of Neurology recommends the establishment of a combined treatment of prednisolone (1 mg/kg/day) and aciclovir (400 mg 5 times/day) during 10 days, it is also recognized that any facial paralysis should be supported as early as possible, ideally within 72 hours, the success largely depends on the rapidity of introduction of treatment.

Peripheral Facial Paresis and COVID-19 Case Report

“…This case suggests that Bell's palsy may be associated with COVID-19 and this infection may be a potential cause of facial paralysis. From a pathophysiological point of view, it has been suggested that peripheral facial paresis may result from facial nerve reactivity in HSV-1 infection and that, as such, episodes of peripheral facial paresis may be caused by stress (or trauma, for example after dental treatment) [15].…”

Lockdown-related idiopathic facial paralysis: illustration of an indirect victim of the COVID-19 pandemic?

“…From a pathophysiological standpoint, it has been suggested that facial nerve paralysis could result from the reactivation of herpes simplex virus type 1 (HSV-1) infection within the facial nerve [2,3,11] and that as such, episodes of facial paralysis could be provoked by stress (or trauma, e.g. following dental treatment [11]), in analogy to herpes labialis [4]. The present case gives credence to such theory, as idiopathic facial paralysis occurred concurrently with a major anxiety episode secondary to COVID-19-related lockdown and subsequent socio-economical repercussions.…”