Podcast
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?
- To measure oral competence
- To evaluate nasal valve function
- To assess symmetry of the forehead (correct)
- To identify smile attributes
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?
- Commissure excursion measurement
- Light and tight eye closure test (correct)
- Rapid eye blink testing
- Nasal valve collapse assessment
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?
- Brow position
- Oral competence
- Malar mounding (correct)
- Nasal valve function
What does the presence of synkinesis indicate during facial examination?
What does the presence of synkinesis indicate during facial examination?
What distinguishes nonflaccid paralysis from flaccid paralysis during the assessment?
What distinguishes nonflaccid paralysis from flaccid paralysis during the assessment?
Flashcards
Facial Examination Zones
Facial Examination Zones
The facial examination is divided into three sections: upper, middle, and lower thirds. Each section is assessed independently to evaluate the overall facial function.
Upper Third Assessment
Upper Third Assessment
Assessing the upper third of the face involves evaluating the eyebrows, eyelids, and eye movements. This includes checking how well the eyebrows move, how tightly the eyes can close, and the presence or absence of the Bell phenomenon, which is a reflex where the eyes roll upwards when the eyelids are closed.
Middle Third Assessment
Middle Third Assessment
The middle third assessment focuses on the mouth and nose. Key aspects include observing the mouth's resting position, how well the corners of the mouth move when smiling, and assessing any nasal valve collapse. Examining the smile's characteristics and comparing them to pre-paralysis photos helps understand the severity and type of smile impairment.
Lower Third Assessment
Lower Third Assessment
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Facial Tone Assessment
Facial Tone 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.
