Podcast
Questions and Answers
What outcome is likely if lagophthalmos is untreated?
What outcome is likely if lagophthalmos is untreated?
Which test can be used to assess lower eyelid laxity?
Which test can be used to assess lower eyelid laxity?
What does a negative vector indicate about the globe's position relative to the orbital rim?
What does a negative vector indicate about the globe's position relative to the orbital rim?
What complication might arise from retraction of the lower lid from the globe?
What complication might arise from retraction of the lower lid from the globe?
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Which of the following findings is associated with eyelid function assessment?
Which of the following findings is associated with eyelid function assessment?
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Study Notes
Facial Assessment for Facial Nerve Dysfunction
- Facial shape and structure assessment identifies contour deformities or soft tissue deficits from prior surgery or trauma.
- Assessment includes atrophy, volume loss, ptosis, tissue heaviness, and skin thickness.
- Look for surgical scars, keloids, hypertrophic scarring, and facial paralysis/treatment indications.
Eyelid Function and Globe Position
- Evaluate upper and lower eyelid function, including voluntary and involuntary blinking.
- Lagophthalmos (incomplete eyelid closure) jeopardizes the cornea; thus, corneal sensation is assessed.
- Incomplete sensation elevates the risk of corneal scarring.
- Assess medial and lateral canthal laxity via gentle manipulations.
- Assess lower eyelid laxity using snap or distraction tests.
- Excessive laxity indicates possible ectropion.
- Ensure lower lid apposition with globe for proper tear-pumping mechanism (lower lacrimal punctum contacting the lacrimal lake).
- Retracted lower lids are associated with epiphora (excessive tearing) and keratoconjunctivitis sicca (dry eyes).
- Exposure keratitis and corneal ulceration are feared sequelae of untreated lagophthalmos.
- Determine vector relationship between globe and orbital rim.
- A negative vector (globe anterior to orbital rim) is identified by a posterior-pointing line from anterior cornea to inferior orbital rim.
- Negative vectors can lead to lower lid malpositioning and increased ectropion risk.
- Prominent eyes (proptosis) also affect treatment.
Facial Nerve Grading Systems
- Several systems grade facial nerve dysfunction.
- The House-Brackmann Facial Grading System (HBFGS) rates motor function on a 6-point scale (I-normal to VI-total paralysis).
- The Sunnybrook Facial Grading System (SFGS) assesses resting symmetry, voluntary muscle excursion, and synkinesis to compute a composite score.
- The SFGS is more reliable and sensitive to recovery changes.
- A 2015 systematic review found the Sunnybrook Facial Grading System (SFGS) to meet all desired criteria for grading facial nerve function, surpassing the HBFGS.
- A revised HBFGS (Facial Nerve Grading Scale 2.0) satisfies most criteria except intraobserver reliability.
- Future research ought to prioritize an objective and universally accepted instrument for global collaboration.
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Description
This quiz evaluates knowledge on facial assessment techniques for identifying nerve dysfunction. It covers key aspects such as facial structure evaluation, eyelid function, and potential complications from conditions like lagophthalmos. Test your understanding of the importance of these assessments in clinical practice.
