The Ophthalmology Unit, Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.
The Ophthalmology Department, SarawakGeneralHospital,
Kuching, Sarawak, East Malaysia.
a
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Lower facial nerve
palsy from mastoid fracture
Photo by Professor Chua
Chung Nen
This 55 year-old woman
fell off her motorbike 8 weeks ago and hit her right temple against the
pavement. She developed a right lower facial nerve palsy. CT scan showed
fracture of the right mastoid bone. Despite a good Bell's phenomenon,
constant topical artificial tear and tapping of the eyelid at night, she
developed exposure keratitis. However, she declined eyelid surgery to reduce
the ocular exposure. A pair of swimming goggles were used as moist chamber
and the exposure keratitis improved after a few days of wear. To reduce
condensation on the inside of goggles, a few needle holes were created on
the goggles.
Figure 1. Right lower facial nerve
palsy showing right eyebrow ptosis and upper eyelid retraction.
Incomplete eyelid closure with corneal and conjunctival exposure.
Figure 2. Swimming goggles used as
moist chamber.
Figure 3. A tight fit is important
for the goggles to act as moist chamber.
Figure 4. CT scan with arrow
pointing to the site of the mastoid fracture.
Figure 5. Another view of the
fractured mastoid bone.
