A Rare Case of Hansen's Disease with Involvement of Buccal Branch of Facial Nerve with Lower Motor Neuron Palsy

Leprosy is a usually disease of peripherally located nerves. In cranial nerves facial nerve followed by the trigeminal nerve being the most frequently affected. The involvement of the zygomatic branch of facial nerve has been reported previously but involvement of its buccal branch is rarely reported. Here, we report a 26 year old male, presented with insidious onset, gradually progressive, swelling and heaviness of the right cheek followed by sudden onset weakness of the right side of his face. Examination revealed an ill defined, hypoaesthetic macule over the right side of face associated with lower motor neuron type facial nerve palsy. The buccal branch of right facial nerve was thickened which was confirmed by ultrasonography and MRI of facial nerve. Histopathology, further confirmed the diagnosis of Hansen's disease (Borderline Tuberculoid). He was managed by Multi Drug Therapy (MDT) (Dapsone, Clofazimine and Rifampicin) and tapering dose of oral Prednisolone along with eye care and physiotherapy with satisfactory outcome.