PMC9326205_01
(a) Photograph of the face of the patient showing severe muscle wasting on the left side above and below the zygoma (black arrows), (b) Neuropathic trace in temporalis left muscle on electromyography(EMG), (c) Brain magnetic resonance imaging(MRI) of the face showing atrophy and fat degenerating of temporalis and masseter (black arrows), (d) Cerebral Brain magnetic resonance imaging(MRI), axial inframillimetric T2 weighted image showing neurovascular conflict between third trigeminal branch and superior cerebellar vein (white arrow)
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Neurological examination showed weakness and hypotrophy of the left temporalis and masseter muscle giving a sunken appearance in the cheek area, weakness of the jaw-closing muscles, and opening deviation [Figure 1a]. Electromyography (EMG) showed that the motor action potential was absent without any abnormal spontaneous activity and with a decreased recruitment pattern and chronic neurogenic motor unit potential changes in the affected masseter and temporalis muscles [Figure 1b], these remained normal in the frontalis, orbicularis oculi, orbicularis oris, sternocleidomastoid, and tongue muscles. Brain magnetic resonance imaging (MRI) of the face and head revealed severe atrophy and fat replacement of the left trigeminal motor nerve innervated muscles (temporalis, masseter, medial, and lateral pterygoid) [Figure 1c] and showed that the superior cerebellar vein crossed in a right angle of the trigeminal branch in the root entry/exit zone (REZ) with deformation of the nerve [Figure 1d].