The Pain that Paralyzed: Myofascial Pain Dysfunction Syndrome as an Initial Presentation of Bell’s Palsy Secondary to Calcified Meningioma

Background Myofascial pain dysfunction syndrome (MPDS) is a common musculoskeletal cause of orofacial pain and may occasionally mimic early neuropathic or neurological conditions, posing a diagnostic challenge for dental practitioners. Case Presentation A 70-year-old edentulous female presented with right-sided orofacial pain and was initially diagnosed with MPDS based on clinical findings. Despite conservative management, she subsequently developed acute unilateral facial paralysis consistent with Bell’s palsy. Temporomandibular joint imaging was unremarkable; however, further evaluation with magnetic resonance imaging (MRI) and computed tomography (CT) of the brain revealed a well-defined calcified extra-axial lesion measuring 1.7 × 1.4 cm at the planum sphenoidale and left olfactory groove, suggestive of a calcified meningioma. Conclusion This case highlights the diagnostic challenge posed by overlapping musculoskeletal and neurological symptoms in orofacial pain conditions. The presence of neurological red flag signs such as progressive facial weakness, persistent or worsening pain, sensory disturbances, or inadequate response to conventional therapy should alert dental practitioners to the need for prompt neurological referral and advanced neuroimaging to exclude underlying intracranial pathology.