Unilateral weakness of the muscles of facial expression.

Volume 89, Number 4 www.aafp.org/afp American Family Physician 283 A 26-year-old man presented with weakness on the right side of his face that occurred abruptly when he awoke that morning. He also had excess lacrimation in his right eye. About three days before onset of the facial weakness, he experienced mild right otalgia that resolved the same day. He did not have fever, visual changes, numbness, or hearing loss, but his sense of taste was altered. He had no significant medical history. Physical examination revealed profound weakness of the muscles of facial expression on the right side (Figure 1). He was unable to activate the right brow depressors (Figure 2) or smile symmetrically (Figure 3). Other neurologic findings were normal. Magnetic resonance imaging of the head, with special focus on the right internal auditory canal, revealed no pathologic findings.