Yawning-induced alternobaric facial palsy in a healthy young adult: A case report and review of the pathophysiology

Background: Alternobaric facial palsy (AFP) is a rare peripheral facial nerve palsy resulting from transient neurapraxia when sudden ambient-pressure changes disrupt middle-ear equilibrium. Common precipitants include scuba diving, air travel, and altitude. AFP triggered by routine activities is exceedingly uncommon. Case report: A healthy 27 year old man developed acute right facial paresis after a prolonged yawn, while in the car. He reported ear fullness, cheek and tongue numbness, and inability to close the right eye, without other neurological sympthoms. Examination revealed a right peripheral facial palsy (House - Brackmann Grade IV), positive Bell's sign, and otherwise normal findings. CT and MRI of the brain and temporal bones showed no lesions. Other causes were ruled-out. Given the abrupt onset, absence of structural pathology, exclusion of other etiologies, AFP was diagnosed. Management and outcome: Prednisone (50 mg, tapered over 3 weeks), eye care, and close follow-up led to full recovery within three weeks. No recurrence occurred at 3, 6, or 12 months. Conclusions: This case highlights an atypical AFP trigger - a simple yawn - and underscores the importance of considering alternobaric mechanisms in acute peripheral facial palsy, even in everyday settings.