- Facial nerve palsy is a complication of parotid abscess that is very rare in occurrence.
- It is mostly found in elderly and immunocompromised individuals.
- The malignancy of the parotid gland should be excluded if facial nerve palsy is present.
A rare case of facial nerve palsy due to parotid abscess
A 44-year-old woman came to the hospital with a complaint of swelling and pain in her left parotid gland for 3 weeks. She also had symptoms of intermittent fever associated with it. Moreover, one week before, she also acquired left facial muscle weakness.
Examination and Investigations
For further evaluation, the doctors performed an examination that revealed a firm and tender lump on the left parotid gland. The lump was about 4 x 4 cm. However, the Stenson duct and the skin overlying the lump were normal. Furthermore, the doctors did not find any cervical lymph node enlargement. The facial nerve examination showed lower motor neuron palsy on the left side.
The doctors performed the contrast-enhanced computed tomography scan of the neck which revealed a homogeneous lesion. It was a thick-walled lesion with peripheral rim enhancement. This confirmed the diagnosis of parotid abscess.
The doctors admitted the patient and treated him with broad-spectrum intravenous antibiotics. Along with this, the doctors gave the modified Blaire skin incision which drained the 10 ml of pus from the parotid abscess. This resolved the pain and significantly reduced the swelling of the parotid gland. However, the facial nerve palsy remained the same and improved after facial physiotherapy.
To exclude malignancy, the doctors performed a biopsy of the abscess, which revealed the normal parotid tissue. She had excellent recovery with the complete healing of the wound at 2 weeks and her facial nerve function returned to normal at 2 months.