Sir,
These are tough times. These are unusual times.
In Singapore, the first confirmed case of coronavirus disease 2019 (COVID-19) infection was detected on January 23, 2020. Since then the number of cases has rapidly increased, and we have gone on to have the highest number of COVID-19 cases in South East Asia.
Usual norms have been changed. Plastic surgeons have suspended all nonurgent and cosmetic cases. This, along with other measures, has led to an increase in bed availability for COVID-19 cases.1
On the surface, the contributions of plastic surgeons during COVID-19 may appear to be limited. However, we form part of the larger, overall response to try and contain this pandemic.
In Singapore, a large number of migrant workers are housed in dormitories. These workers have represented the majority of recent COVID-19 cases in Singapore. The treatment of this pool of people has largely changed from bringing them to a hospital, to taking doctors and nurses to the dormitories. Along with other healthcare workers, plastic surgeons have volunteered to visit dormitories to help ease the handling of the increasing number of COVID-19 cases. Makeshift tents are erected to test and manage inhabitants in the dormitories. Dormitory residents with symptoms of respiratory infection are swabbed. These are not ideal conditions, and extra caution is warranted.
During one of these visits, a 42-year-old man presented with a 1-week history of facial “weakness” that was not improving (Fig. 1). On examination, he had a facial palsy, and our provisional diagnosis was Bell’s palsy. A swab test for determining coronavirus infection was performed, and the result came back positive.
Fig. 1.
A 42-year-old male patient with unilateral facial palsy. Note the weakness of the left orbicularis oculi compared with the right. There is asymmetry of the lower lip, indicating weakness of the affected orbicularis oris.
The exact cause of Bell’s palsy is unknown. It is believed that the palsy is viral in origin, with edema and demyelination of the nerve.2 A literature review yielded an online case report of Bell’s palsy in a COVID-19-positive patient, and the authors suggest that neurological symptoms could be the first manifestation in patients with asymptomatic or mild infection.3
In conclusion, we hope that this finding serves as a timely reminder for plastic surgeons and other readers to remain vigilant of Bell’s palsy in the current COVID climate.
Footnotes
Published online 14 September 2020.
Disclosure The authors have no financial interest to declare in relation to the content of this article.
REFERENCES
- 1.Chang Liang Z, Wang W, Murphy D, et al. Novel coronavirus and orthopaedic surgery: early experiences from Singapore. J Bone Joint Surg Am. 2020;102:745–749. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kosins AM, Hurvitz KA, Evans GRD, et al. Facial paralysis for the plastic surgeon. Can J Plast Surg. 2007;15:77–82. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Wan Y, Cao S, Qi F, et al. Coronavirus disease 2019 complicated with Bell’s palsy: a case report. Res Square. 2020[E-pub ahead of print]. [Google Scholar]