5th OR 7th cranial nerve ??

[emad]

Hi all:

Today , i received a referred patient under the diagnosis of facail palsy , however , i can not conclude that he is pure facail palsy .

36 years male , with onset of pain and tenderness since 7 days , he could not open his mouth for eating even , numbness along this face side Right .

Even i could not complete the examination process because of pain .

He can close well the eye , shoing teeth very well .

Palpation referred pain just anterior to his ear .

Cheers

Emad

[Diane]

Hi Emad,
You seem to get your fair share of these, don't you? Doesn't sound like a palsy, sounds like a pain state.
The differential I learned included parotid gland.. is it swollen? Infected? Is there an intraoral swelling pushing from inside, as in from a real bad tooth infection? Is there a swelling of a submandibular gland taking up too much room and creating tension for the facial nerve? The treatment I learned involved lightly and gently contacting the face over the angle of jaw, feeling one's way along, carefully engaging and 'stretching' the masseter.. then the jaw will usually open up easier.
Diane

[emad]

Hi Diane :

i saw this consumer since 2 hours , this is the second visit .

Actually , i dealt with him as trigger point just over the TMJ (Tempromandibular joint ) , i applied Ultrasonic pulsed for 45 seconds only , very very very gentle pressure , teached him how to relax his face and mandibule .

Today , he reported pain decreased by 60 % , all TMJ movements improved , but he told me at the night of first visit to me there was great pain and headache .

Also , today i got the chance to assess and listen to him , because at first visit he could not speak .I feel that the issue is more like TMJ and mastication muscles spasm and trigger point , i have no other hypothesis to consider , however , before that consumer i began to throw away from my work the hyptheses of TRIGGER POINT , but all neuro-thories did not provide me reasonable hypothesis for this patient .

The neck muscles also were tender , i applied very gentle soft tissue mobilisation and neck movements.

By the way,I avoided to apply and stretching , as i abelive all stretchs could aggrevate the tension state of muscles .

Oh , this consumer visited dentist ,GP before me .
cheers
Emad

[emad]

Have any one heared about ;
Costen's syndrome ???

cheers
Emad

[bernard]

Hi Emad,
It was the first time I heard about this syndrome => :oops:
Costen's Syndrome (http://www.gpnotebook.co.uk/cache/-489684988.htm)

[emad]

Hi Bernard ;


http://www.step.es:8000/personales/jlarena/indexing.htm

yes, you are right through that link .

My friends,

I belive breathing exercises are very very effective/beneficail fr that above patient.

cheers

Emad