Facial Examination Techniques

What is the primary theory explaining the incorrect reinnervation of muscle groups after nerve injury?

Which phenomenon is associated with aberrant nerve regeneration leading to unintentional muscle contractions?

What should be particularly assessed during a complete cranial nerve evaluation in facial paralysis cases?

Which condition is NOT typically associated with concomitant palsies in facial paralysis?

What is a common clinical sign of synkinesis observed in patients?

What does the assessment of the upper third of the face primarily involve?

Which characteristic is assessed to differentiate between flaccid and nonflaccid paralysis?

Which symptom is closely associated with synkinesis in facial paralysis?

What finding in the middle third of the face examination is evaluated alongside the smile?

Which factor is NOT mentioned as influencing the development of synkinesis?

Facial Examination

Facial examination involves evaluating the upper, middle, and lower thirds of the face independently.
Observe facial appearance at rest and during motion.
Upper Third: Assess baseline brow position, brow elevation, eye closure (light & tight, rapid blink), and the Bell phenomenon.
Middle Third: Assess mouth position at rest, commissure excursion (light and full smile), measuring asymmetry, and comparing dental display, malar mounding, and nasolabial creases. Photographs of pre-paralysis smiles can provide a baseline for comparison. Evaluate nasal valve collapse using the Cottle and modified Cottle maneuvers.
Lower Third: Assess oral competence (lip puckering and lower lip depression).
Facial Tone: Separated from movement; assessed at rest and with effort.
- Flaccid paralysis: Loss of all tone at rest.
- Non-flaccid paralysis: Maintenance of tone without significant movement.
- Synkinesis: Abnormal increase in tone, characterized by unintentional movement of one facial area during intentional movement of another. This is a crucial symptom requiring attention, as it can be the most distressing consequence of facial paralysis. Several factors influence the development of synkinesis, including neural injury's degree and location, aberrant nerve regeneration, ephaptic transmission, and nuclear hyperexcitability.
Synkinetic Movements: Include (but are not limited to) unintentional periocular contraction with mouth movement, narrowed palpebral fissures, and platysmal contraction during smiling.

Further Assessment

Complete cranial nerve assessment is crucial, especially for trigeminal, vagal, hypoglossal, and contralateral facial nerve function.
Evaluate masseteric and temporalis muscle function.
Assess for concomitant palsies (e.g., Lyme disease, sarcoidosis) or intracranial causes.
Neurologic assessment is important for selecting reanimation techniques (e.g., nerve or muscle transfer procedures).

This quiz focuses on the techniques and assessments involved in facial examination, evaluating the upper, middle, and lower thirds of the face. It covers aspects such as facial appearance, tone, and movement, including specific tests like the Bell phenomenon and the Cottle maneuver. Perfect for students learning about facial analysis in medical or cosmetic fields.