Persistent Unilateral Nerve Paresthesia Following Suspected Viral Infection

The infraorbital nerve, a terminal branch of the maxillary division (V2) of the trigeminal nerve, supplies sensation to the upper lip, lower eyelid, and midface. Neuropathy in this distribution typically presents as paresthesia with or without anesthesia, dysesthesia, and/or allodynia. While trauma, dental pathology, sinusitis, and certain neurological conditions are possible causes, emerging literature has identified post-viral neuropathies, including cranial mononeuropathies, as potential sequelae of COVID-19. This case highlights a rare presentation of presumed post-viral infraorbital neuropathy following an upper respiratory illness suspected to be COVID-19. A 34-year-old male with controlled hypertension developed unilateral paresthesia of the upper left lip and infraorbital region following a presumed viral illness. Multidisciplinary evaluation included imaging (CT, panoramic, and intraoral radiographs), nasal endoscopy, bloodwork, and dental assessment. An infraorbital nerve block with bupivacaine was used diagnostically to confirm localization. No dental, neoplastic, or significant sinus pathology was identified. Symptoms persisted despite corticosteroids and antibiotics. Infraorbital nerve block reproduced symptoms of paresthesia and temporarily eliminated pain, confirming the affected nerve region. Given the timing postinfection and absence of structural causes, a working diagnosis of post-viral infraorbital neuropathy was established. This case underscores the importance of including post-viral neuropathy in the differential diagnosis of facial paresthesia, particularly following respiratory infections like COVID-19. Diagnostic nerve blocks can aid both localization and symptom relief. As post-viral neurological sequelae become more recognized, clinicians must consider cranial nerve involvement even in the absence of confirmatory testing or imaging abnormalities. A multidisciplinary approach remains essential for accurate diagnosis and effective management.