49-year-old gentleman reported with complaints of tightness of jaw, numbness of tongue and inability to swallow for 3 days. He had a history of intermittent fever, altered taste and smell of two-day onset with history of Diabetes Mellitus, Systemic Hypertension and Dyslipidaemia. Nested real time RTPCR throat/nasopharyngeal swab for SARS CoV -2 was negative, while CT chest had typical patterns seen in COVID 19 pneumonia with a score of 5/25. Haemodynamically stable, normal vitals, SpO2 > 95% on room air, single breath count of 15. Bi-facial LMN weakness, left HB Gr.IV > Right HB Gr III, restricted jaw movements, diminished gag, normal motor, sensory examination and cerebellar findings. 3-Tesla MRI Brain with contrast was normal. Deviated lip, symmetrical tongue with slow alternating movements. Symmetrical velum elevation. Normal perceptual voice rating, strong volitional cough. Labial distortions with normal speech fluency and prosody. Bedside swallow evaluation denoted mild anterior spillage, increased effort in swallowing, with palpable adequate laryngeal elevation, no noticeable signs of aspiration after swallow. Speech and swallow rehabilitation with non-speech isometric and isotonic exercises, in speech with articulatory drill and bio feedback, incentive spirometry and deep breathing exercises was initiated. Normal Upper and lower limb Nerve conduction study. CSF showed albumin cytological dissociation. Anti-ganglioside antibodies were negative. He was treated with antiviral, antibiotics, bronchodilators, corticosteroids. On 3rd week follow up, he showed remarkable improvement in his oral motor functions, speech and swallowing (Table 3). Mild residual facial weakness was noted on the left HB Gr.III.
