Ramsay hunt syndrome: A diagnostic challenge for dental prac
A 48-year-old male reported to our department with a chief complaint of multiple eruptions on the right side of face. He also complained of severe pain in oral cavity along with inability to open the mouth.

He was afebrile, with pulse and blood pressure within normal limits and no lymphadenopathy. He was diabetic for the past 4 years and under medication for the same. Focal neurological deficit in the form of lower motor neuron facial palsy was noticed. He was referred further for dental evaluation.

On physical examination, multiple vesicles along the right side of face involving tragus of ear, auditory canal above ear, lateral side of forehead, lateral margin of eye, lower lip, and right mandibular parasymphyseal region were seen [Figure 1] and [Figure 2]. Intraoral examination revealed multiple vesicular eruptions on right buccal mucosa and right half of labial mucosa.

Ear, nose, and throat specialist's evaluation revealed tympanic membranes congested in the right ear with blebs. Audiometric analysis was done to rule out any sign of deafness which revealed mild conducive hearing loss. Ophthalmology evaluation showed no relevant pathological findings.

Diagnosis of RHS was made based on the history of varicella infection and the current clinical presentation. Laboratory investigations such as hemogram, urine routine, serum electrolytes, serum glutamic pyruvate transaminase, peripheral blood smear, and blood and urine culture sensitivity results were normal.

Oral vesicles were subjected to Tzanck smear which revealed multinucleated giant cells. He was treated without delay and was prescribed with tablet acyclovir 800 mg five times a day, tablet paracetamol 500 mg 6 h, tablet carbamazepine 200 mg thrice daily, and tablet methylcobalamine 1500 mg once daily. He was also advised physiotherapy for facial paralysis.

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