Diving Induced Facial Paralysis

[octotat]

I would like to mention a situation that happened to my diving partner a few years back while doing a liveaboard on the Great Barrier Reef. About a half hour after returning topside from a 60 foot 35 minutes dive, my partner mentioned that his lip was numb. This numbness seemed to creep throughout the whole side of his face, causing it to droop. The other side of his face was fine. We inspected him for any stings or welts and could find none. Fearing a stroke or dcs, we put him on O2. This lasted for about 1/2 hour, at which point he felt some crackling and air release from the ear on the paralysed side of his face and the paralysis immediately went away. It seemed that he had a reverse block that was possibley pressing on a nerve causing the paralysis, much like a bells palsey. Has anyone ever heard of this symptom from diving? Any thoughts?

 

[Saturation]

I would like to mention a situation that happened to my diving partner a few years back while doing a liveaboard on the Great Barrier Reef. About a half hour after returning topside from a 60 foot 35 minutes dive, my partner mentioned that his lip was numb. This numbness seemed to creep throughout the whole side of his face, causing it to droop. The other side of his face was fine. We inspected him for any stings or welts and could find none. Fearing a stroke or dcs, we put him on O2. This lasted for about 1/2 hour, at which point he felt some crackling and air release from the ear on the paralysed side of his face and the paralysis immediately went away. It seemed that he had a reverse block that was possibley pressing on a nerve causing the paralysis, much like a bells palsey. Has anyone ever heard of this symptom from diving? Any thoughts?

Almost certainly a type of bell's palsy, but strictly a facial nerve compression. The nerve exits around the ear, and a substantial compression here can cause a palsy.

http://info.med.yale.edu/caim/cnerves/cn7/cn7_graphics/fig7_1.gif

 

[d33ps1x]

That is just truly bizarre! I think I'll slow my ascent rate again.

 

[Saturation]

Its somewhat unusual because typically enough built up gas to cause such an issue, which is benign and temporary, is painful and inevitably ruptures the ear drum.

 

[octotat]

I should note that he did not feel any pain during ascent, the ascent was done extremley slowly with a 3 min safety stop. He also never felt any pain after the dive. We joke about the whole episode now, but at the time it was very unnerving (no pun intended about a pinched nerve)

 

[justleesa]

Wow! That just happend to a dive guest this week on the boat and it was diagnosed as a reverse block, baratrauma with a pinched facial nerve. As soon as the reverse block passed the ladies face went back to normal.

 

[Sixtiesdiver]

Wow! That just happend to a dive guest this week on the boat and it was diagnosed as a reverse block, baratrauma with a pinched facial nerve. As soon as the reverse block passed the ladies face went back to normal.

I just came on this thread and found it useful. I've dived
on and off since 1968 and never had this happen.

However after a dive this Febuary I seemed to develop
a small area of "numbness" in my lower lip. It was only
small and was mainly noticable when brushing my lower
teeth. As the toothbrush went past the inside of my
mouth below the lip, a sharp yet non-painful twinge
could be felt on a part of my lip immediately above.

It felt as if I had a hair caught there. The effect lasted
about a week fading gradually away.

The dive was shallow - max 5m for 45 min but it was
quite cold. I had put the numbness down to the cold
but I've dived in colder deeper fresh water since without
this effect occurring again.

Perhaps it was a mild version of this effect?

 

[Laurence Stein DDS]

Saturation,

This is an interesting one. It sounds like a Bell's Palsy
BUT the diver mentioned numbness of the upper lip and what sound's like crepitis. Perhaps we are assuming that the sound was from the ear. Like you, I would have thought there would be pain in the ear had this been the area affected.

While the 7th nerve exists near the ear and the chorda tympani crosses the ear drum (to the tongue) I have a feeling that the area of nerve impingement was more consistent with an area near the infraorbital canal or foramen.

It is possible for air to be injected into the parotid gland during clearing procedures and it would expand on ascent. The Facial Nerve penetrates the parotid gland and could be temporarily compressed. When the area finally decompressed, a crackling sound might be noted...creptitis and bone conduction to the ear.

Further, if this was a case of compression external to the infraorbital foramen, any local nerve fibers in the area might be involved rather than the main nerve trunks. Lip paresthesia AND facial palsy might be noted. I have a "feeling" that this might be an odd sort of maxillary sinus barotrauma much like the ones that only result in lip and tooth numbness.

If there had been a barotrauma at the base of the skull where the Facial Nerve and the Trigeminal Ganglion or branches of the Trigeminal Nerve are located, I would expect the paresthesia to involve more branches of the Trigeminal Nerve as well as portions of the Facial Nerve distribution. I would also expect that the effects would also be more lasting...perhaps weeks.

If this recurrs, perhaps an ENT consult is advisable.

Sixtiesdiver,

An unexplained lower lip paresthesia (numbness) should be checked. It might be totally unrelated to diving. Trauma from the regulator over the Mental Foramen could result in this as well as infection, cysts or neoplasms withing the mandible. I don't want to be alarmist but a simple x-ray from the dentist can rule out most of these problems. My money would be on trauma...check the outer edge of your regulator bite. If it impinges on the gums below the 1st and 2nd bicuspids (lower, behind the canines) then you might want to trim the bite material.

Safe Diving and regards,

Laurence Stein, DDS
:doctor:
Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)

 

[gazzahawkes]

Hi,

Just want to say well done for putting him straight on 02 in my experience as instructor and dive medic tech most instructors still show denial that something is wrong. In this case pressure on facial nerve can cause this ive seen it twice now with ear barotraumas.On the other hand cranial nerve damage is a sure sign of of cerebal dcs.

Great to see there are bods out there that handle this istuation correctly on the boat.

cheers gary

 

[Saturation]

Larry's suggestion is equally plausible. The numbness would work its way down the cheek as the nerve exits just below the eye [#3 in the image], with the numbness localized to that area.

However, the nerve here is purely sensory, so numbness is mostly the result. If Drooping or paralysis was a primary symptom too, the key motor nerve would be the facial nerve. If the branches of the facial nerve are affected separately by maxillary sinus issues, the weakenss will be distributed only to that branch, see the yellow and orange lines on the URL to Yale here:

http://www.scubaboard.com/showpost.php?p=558021&postcount=2