the motor components were always what were drilled into our skulls in anatomy class via the following neumonic Two Zebras Bit My Cookie (of course, that’s the PG version, we had lots of fun with that one) i have some really gross neumonics for the cranial nerves, too!

thanks for your insight!

Gross anatomy was after lunch and as much as I tried I really had a hard time staying awake in that class. The lights would go lower, the slides would go on and I would be done…

Firstly to be horribly pedantic, the facial nerve DOES actually have sensory components. Via the greater petrosal nerve branch it provides taste to the palate and via the chorda tympani it provides taste to the anterior two thirds of the tongue. You are absolutely right, though, in saying that the five motor branches (zygomatic, buccal, mandibular, cervical…god I always forget the last one…temporal!) have no sensory component.

I’m sure everyone has considered that Bell’s Palsy could have been caused if anaesthetic solution was injected into the capsule of the parotid gland during administration of an inferior alveolar nerve block. The paralysis would have tended to be more immediate, as you said…I seriously doubt it would have taken two days to develop.

It is in the realm of conceivable possibility that if the gland capsule was punctured during a block, it may have caused inflammation (and/or oedema and haemorrhage) which may have caused compression of the nerve and *that* could take a day or two to manifest. That’s a lot of qualifiers though.

It’s more likely that the extraction had very little to do directly with the paralysis. Indirectly it could have caused something like a Ramsay Hunt Syndrome if he was stressed out and had that suppressed his immune system. But I’d be tending to agree that the palsy is most likely coincidental. He could suddenly be having symptoms from a parotid neoplasia. For all we know he could have had a stroke.

What gets me in cases like this is when people start making wild accusations about other peoples “mistakes” without actually knowing the particulars. Makes me want to grab the person and go “You weren’t there, you don’t know the case, please shut-the-f*ck-up!”.

Actually, your case brings to mind a case that one of the endo exam candidates presented to the committee. Same sort of thing. Bell’s Palsy 2 days after a molar endo was done on this side. The candidate said it was idiopathic and we had to concur because none of us could logically link a dental cause to it.

Maybe one of the oral med people who read this has some ideas…

three days later, he called back with paralysis of the right side of his face, inability to close his right eye. i told him to come in immediately, and at this point i was freaking out. sure enough, his right side was drooping, but all of his sensory function was intact. it was a classic case of bells palsey, but it couldn’t have been induced by my anesthesia because it presented itself two days after the extraction and he left my office with no apparent distress. it could have been brought on by the trauma of the extraction itself, compromised immune system, reaction to the antiobiotics, whatever (looking back, one of the prodromal signs of bells palsey is facial pain, and that could have been completely unrelated to the broken #48, the tooth just coincidently there) but of course, he blamed me because guess what, his cousin, who is an orthodontist, told him that numbness was a side effect of tooth extraction and that his paralysis was my fault.

umm, okay, do you have any knowlege of head or neck anatomy? do you know the difference between motor and sensory nerves? don’t you know that facial movement is regulated by the five branches of the facial nerve, which has no sensory function? did you bother to see that his IAN function was completely intact? i sent him bcak to his family physician for further evaluation and i never saw him again. at least, he never came back to complain to me again.

drives me crazy when people pull crap like that on me.

You’d think an orthodontist would know that that was a risk factor of treatment?