Brief Answer:
ENG and EMG recommended.

Detailed Answer:
Hello.

I read your query carefully and I am sorry about what you are experiencing and the anxiety it is causing you.
I also read the exchanges you have had in the past week with my esteemed colleagues Dr. Ranxha and Dr. Fejzo from which I learned that you also had an MRI and a dental evaluation which came back normal.

First of all I don't think either that this has been caused directly by alcohool and drugs. Yes they cause neurological symptoms at times, but after 4 months their effect would have vanished.

You say that you have had a neurological exam and it was normal, but on the other hand you mention that when you see yourself in the mirror your left eyelid is drooped which is abnormal. Did you ask the doctor who performed the exam about that? Did he notice it too or did he disagree? Also at times people have congenital light asymmetry of the face, have you considered the possibility of it having been there before and you noticing it only after that drunken night? You might want to check for some older photo just to be sure it wasn't present in the past.

Regarding neurological causes: since MRI was normal it can be excluded that the signs are relatedd to brain lesions.
That leaves the possibility of a peripheral involvement of nerves. From your symptoms could be a mild facial palsy a trigeminal nerve branch involvement.
If a facial palsy it could cause the drooping and asymmetry. I think it would've shown in neuroexam but since we are crossing out all options, only thing left would be electrophysiological testing including nerve conduction testing with EMG. If there is an involvement of facial nerve and muscles that will show it and its extent. If there is none then I really don't see how facial nerve and muscles could be involved and if the doctor doesn't notice the asymmetry I would consider the possibility of it being just your impression.
As for the trigeminal nerve involvement as you had found yourself main nerve affection is manifested by intense, stabbing pain so doesn't look likely. As for a more distant branch involvement that could have many causes, some would have been noticed by MRI, others by dental evaluation. If the electrophysiological testing comes back normal, even though dental visit is reported normal, I think reasons related to jaw or salivary glands are more likely and a reevaluation by a oro-maxillo-facial specialist is necessary.

I am at your disposal for further questions

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Brief Answer:
Recommended tests could help in predicting long-term outcome

Detailed Answer:
It's a little difficult to answer to the question on whether the palsy will disappear when a neurologist, a specialist trained to notice that kind of change, says there is none.

However as I said before there is an objective test to assess that, which is the electrophysiological nerve studies (ENG, EMG) to assess the function of the facial and trigeminal nerve. If indeed there results an impairment of the nerve, it can assess the degree and help in making a prediction. Generally speaking when it is the common Bell (facial palsy) it will recuperate in time especially in a young person like you, but have to affirm that first.

Also I didn't mention before that when a trigeminal neuropathy of unexplained cause is suspected, apart from ENG/EMG it should be investigated about non-local causes like connective tissue autoimmune diseases which could present with unilateral trigeminal neuropathy, in particular Sjogren's syndrome. I don't think it as likely and usually they have other symptoms, just looking to be as thorough as possible.

In the meantime, looking back at your statement that you'll go crazy if it's permanent, please try not to overthink the issue. I understand that you want to know the why, but when we as doctors say that the exams don't show anything that shouldn't necessarily be a reason for panic, instead you should be relieved that no serious cause like a brain tumor, infection or multiple sclerosis is found. I would have understood if it was a disfiguring facial palsy, but if the doctors say they don't notice it at all, I can't imagine it being so esthetically unpleasing even if present. So go on with your scheduled appointment and exams but in the meantime try to relax and lead your normal routine.

I hope everything will work for the best.

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Brief Answer:
EMG and follow up

Detailed Answer:
It's good that you've been tested for autoimmune disease, one nastier thing ruled out. Let's hope EMG will give us more info. If not, as I said an oro-maxillo-facial specialist evaluation for that pain, although I'm confident since the first dental came out fine nothing serious will be found and you'll continue with only follow up visits to check for the evolution.

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Brief Answer:
Peripheral facial nerve palsy unlikely.

Detailed Answer:
Hello.

Thank you for the image.

By the way you say in your initial question, it was the right side of face drooping while now you say it's the left eye, a typo I suppose.

I checked the photo carefully for peripheral nerve palsy signs (since central causes are excluded by MRI). Facial palsy doesn't cause ptosis (drooping of the eye lid) usually it's the opposite which can give the impression of ptosis on the healthy side. If there was only an isolated ptosis which has subsided I might have added myasthenia gravis among the diagnostic possibilities but you add also that pain and the numbness which are not part of its picture.

Since it usually causes a widening of the palpebral fissure (the opening gap between your lids) compared to the other side, I even measured it using photo editing software and the palpebral fissure was bilaterally the same. There is also sagging of the lower eyelid which is not visible in your case.

You also say it has come out, but that's not visible by that angle.
Of course, there are other signs which are evaluated dynamically (raising eyebrows, shutting eyes tight, smiling, puffing cheeks) and can't be evaluated by the photo, so I am not saying that I exclude it especially since you say that it was worse before, might be on the way of recovery.

Anyway if I'm wrong the EMG will evidence it.
If it has improved though then it's a good sign indicating it will get better.

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Brief Answer:
Nothing to worry about.

Detailed Answer:
Hi,
It's okay, I already imagined it was a typo.
As I said before try to relax and not think too much about it, everything coming back normal is a positive thing and I am confident all will be back to normality soon.
MRI has already ruled out serious conditions and EMG will make sure there is no other peripheral nervous system condition.

Regards,

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Brief Answer:
Nothing wrong with your face.

Detailed Answer:
From what you said earlier i didn't think the pain was intense, sounded more like a case of numbness with mild pain when pressing over that region. If pain is really bothersome and no other local cause found by oro-maxillo-facial specialist then treatment for neuropathic pain could be tried. The alternatives are usually amitryptiline which you are already on, but if that is deemed ineffective another alternative is anti-epileptics. It has to be prescribed by your neurologist and only if pain is really bothersome.

Don't worry about sounding annoying, I don't mind answering if I can be of help, but our exchange makes me worried about you having anxiety issues. I am not saying that in the sense that nothing was ever wrong with your face, but in the sense that you don't seem to be coping well with it.

One thing I can say with 100% certainty, at least for the upper part of your face which can be seen in the photo, is that there is absolutely nothing wrong with how your face looks. Just look back at our conversation, you seem to be complaining that before your eyes were asymmetrical while now they look perfectly the same. I mean, if that was the case some people would pay a plastic surgeon to achieve that.

So as I said whether there is some degree of nerve injury or not, it is evident that you seem to be having some trouble coping with it. Nothing wrong with that, anxiety is a common problem affecting many people especially when faced with a stressful situation. While you follow up with your neurologist and the recommended tests and treatment, you should also try to address these anxiety issues, if not possible by yourself perhaps you could ask for the help of a psychologist for relaxation techniques.

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Brief Answer:
No visible facial palsy.

Detailed Answer:
I looked carefully at both photos. I really can not discern any signs of a facial nerve impairment there, nothing at all. There's visually nothing wrong with your face. If there was any difference with the before pic that was because your smiling lit your whole face up, not because there is any neuropathy (and please don't force me to say over and over that your face looks nice, it might seem inappropriate :P ).

Anyway the EMG would show the damage if any. Looks like a win win situation for you, if normal you can put your mind at rest and if not, you will have proven wrong one live and two virtual neurologists as well as a virtual neurosurgeon (just kidding, I know that your health is what matters to you).

Again, no visible palsy, for the abnormal feeling if amitriptyline fails then antiepileptics could be tried if really bothersome to make it go away, but certainly your looks haven't suffered because of it.

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