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Questions and Answers
What is the purpose of observing brow elevation during the upper third facial examination?
What is the purpose of observing brow elevation during the upper third facial examination?
Which test helps determine the presence of Bell phenomenon during the facial examination?
Which test helps determine the presence of Bell phenomenon during the facial examination?
What facial feature is compared between the normal and paralyzed sides during the middle third assessment?
What facial feature is compared between the normal and paralyzed sides during the middle third assessment?
What does the presence of synkinesis indicate during facial examination?
What does the presence of synkinesis indicate during facial examination?
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What distinguishes nonflaccid paralysis from flaccid paralysis during the assessment?
What distinguishes nonflaccid paralysis from flaccid paralysis during the assessment?
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Study Notes
Facial Examination
- Facial evaluation is divided into upper, middle, and lower thirds, assessing both rest and movement.
- Upper third: Evaluates brow position, elevation, eye closure (light & tight, rapid blink), and the Bell phenomenon.
- Middle third: Assesses resting mouth position, commissure excursion (with light & full smiles), and compares involved vs. normal sides for asymmetry. Includes dental display, malar mounding, nasolabial crease, and nasal valve collapse (Cottle/modified Cottle). Photos of pre-paralysis smiles can be helpful.
- Lower third: Tests oral competence (puckering lips, depressing lower lip).
Facial Tone
- Facial tone is separate from motion and assessed at rest and with effort.
- Flaccid paralysis: Loss of all tone at rest
- Nonflaccid paralysis: Maintenance of tone without significant movement.
- Synkinesis: Abnormally increased tone where unintentional movements occur during intentional movements. This is a significant symptom that needs detailed attention.
- Causes of synkinesis: Several theories. Widely accepted theory is aberrant nerve regeneration, where axons reinnervate incorrect muscles. Other possibilities include ephaptic transmission (artificial synapses) and nuclear hyperexcitability (following Wallerian degeneration). Synkinesis severity & muscle groups affected vary.
- Common synkinetic movements: Unintentional periocular contraction with mouth movement, narrowed palpebral fissure, and platysmal contraction with smiling.
Comprehensive Assessment
- Complete cranial nerve assessment is essential, paying special attention to trigeminal, vagal, hypoglossal, and contralateral facial nerves.
- Masseteric and temporalis muscle function is assessed.
- Concomitant palsies (e.g., Lyme disease, sarcoidosis) and intracranial causes should be considered.
- Neurologic assessment guides reanimation techniques (e.g., nerve/muscle transfers).
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Description
Explore the various techniques for evaluating facial structures, focusing on the upper, middle, and lower thirds of the face. Learn about assessment criteria such as brow position, mouth posture, and facial tone, including flaccid and nonflaccid paralysis. This quiz is essential for understanding facial assessments in clinical settings.
