Six months after recovering from a right-sided Bell's palsy, a patient notices tearing from the right eye while eating spicy food. The underlying mechanism is:

• A Regeneration of secretomotor fibres destined for the submandibular gland into the lacrimal gland pathway ✓
• B Reactivation of latent varicella zoster virus in the geniculate ganglion
• C Denervation supersensitivity of the lacrimal gland to circulating adrenaline
• D Aberrant regeneration of motor fibres into the nerve to stapedius

Explanation

This is Bogorad syndrome (crocodile tears), a post-paralytic aberrant regeneration phenomenon. Preganglionic parasympathetic fibres originally meant for the submandibular and sublingual glands via the chorda tympani regenerate along the greater petrosal nerve and reach the pterygopalatine ganglion and lacrimal gland, so salivary stimuli produce lacrimation. VZV reactivation causes Ramsay Hunt syndrome, not gustatory lacrimation, which kills option B.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.