{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:04:56Z","timestamp":1784714696776,"version":"3.55.0"},"reference-count":7,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Peripheral facial palsy is often attributed to idiopathic Bell\u2019s palsy, but secondary structural causes should be considered when local red flags are present. A 61-year-old man with a 40-pack-year smoking history and former betel quid chewing presented with a verrucous-appearing mass involving the left oral commissure and buccal mucosa, intermittent purulent discharge from the lesion, progressive left facial swelling, and ipsilateral lower-motor-neuron facial palsy with lagophthalmos. Magnetic resonance imaging demonstrated a left buccal\/oral-cavity lesion with ipsilateral parotid duct obstruction. He underwent tracheostomy, wide excision, left supraomohyoid neck dissection, and radial forearm free-flap reconstruction. Pathology confirmed squamous cell carcinoma, pT2N0, cM0 (stage II), with perineural invasion; surgical margins were negative, and lymphovascular invasion was not identified. At follow-up, wound healing was satisfactory and purulent discharge had resolved, but lower-motor-neuron facial palsy persisted; adjuvant radiotherapy was recommended. This case emphasizes that lower-motor-neuron facial palsy with an oral mass, purulent discharge, facial swelling, or salivary-duct obstruction should prompt careful oral examination and head-and-neck imaging.<\/jats:p>","DOI":"10.3390\/diagnostics16142289","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:20:39Z","timestamp":1784712039000},"page":"2289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Lower-Motor-Neuron Facial Palsy Revealing Buccal Squamous Cell Carcinoma with Parotid Duct Obstruction and Perineural Invasion"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6255-3071","authenticated-orcid":false,"given":"Yu-Cheng","family":"Chu","sequence":"first","affiliation":[{"name":"Department of Neurology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan"},{"name":"Graduate Institute of Management, Chang Gung University, Taoyuan City 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Yi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan"},{"name":"School of Dentistry, National Taiwan University, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0484-4708","authenticated-orcid":false,"given":"Wen-Chih","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1038\/sj.bdj.2009.1009","article-title":"Causes of oral cancer\u2014An appraisal of controversies","volume":"207","author":"Warnakulasuriya","year":"2009","journal-title":"Br. Dent. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/j.1600-0714.1995.tb01132.x","article-title":"Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan","volume":"24","author":"Ko","year":"1995","journal-title":"J. Oral Pathol. Med."},{"key":"ref_3","first-page":"S1","article-title":"Clinical practice guideline: Bell\u2019s palsy","volume":"149","author":"Baugh","year":"2013","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.oraloncology.2011.08.002","article-title":"Perineural invasion in oral squamous cell carcinoma: A discussion of significance and review of the literature","volume":"47","author":"Binmadi","year":"2011","journal-title":"Oral Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.ijrobp.2018.12.009","article-title":"Perineural invasion and perineural tumor spread in head and neck cancer","volume":"103","author":"Bakst","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","first-page":"22","article-title":"Perineural spread in head and neck malignancies: Imaging findings\u2014An updated literature review","volume":"22","author":"Medvedev","year":"2022","journal-title":"Biomol. Biomed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1055\/s-0036-1571837","article-title":"Pathology of perineural spread","volume":"77","author":"Brown","year":"2016","journal-title":"J. Neurol. Surg. B Skull Base"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:38:40Z","timestamp":1784713120000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":7,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16142289"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16142289","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]}}}