Podcast
Questions and Answers
What condition may arise from untreated or unrecognized lagophthalmos due to eyelid paralysis?
What condition may arise from untreated or unrecognized lagophthalmos due to eyelid paralysis?
Which test can be used to assess the laxity of the lower eyelid?
Which test can be used to assess the laxity of the lower eyelid?
What aspect do the House-Brackmann Facial Grading System and the Sunnybrook Facial Grading System primarily assess?
What aspect do the House-Brackmann Facial Grading System and the Sunnybrook Facial Grading System primarily assess?
Which grading system was recommended for adoption as the current standard based on fulfilling multiple evaluation criteria?
Which grading system was recommended for adoption as the current standard based on fulfilling multiple evaluation criteria?
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What indicates a negative vector relationship between the globe and the orbital rim?
What indicates a negative vector relationship between the globe and the orbital rim?
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What is the highest grade in the House-Brackmann Facial Grading System?
What is the highest grade in the House-Brackmann Facial Grading System?
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What risk is associated with absent corneal sensation during eyelid assessment?
What risk is associated with absent corneal sensation during eyelid assessment?
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Which of the following conditions is likely to occur when the lower lid is retracted from the globe?
Which of the following conditions is likely to occur when the lower lid is retracted from the globe?
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Which feature is NOT included in the evaluation criteria for grading facial nerve function instruments?
Which feature is NOT included in the evaluation criteria for grading facial nerve function instruments?
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What is one limitation noted in the revised House-Brackmann Facial Grading System, Facial Nerve Grading Scale 2.0?
What is one limitation noted in the revised House-Brackmann Facial Grading System, Facial Nerve Grading Scale 2.0?
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Study Notes
Facial Assessment for Facial Nerve Dysfunction
- Facial shape and structure examination assesses contour deformities, soft tissue deficits (atrophy, volume loss, ptosis) and skin thickness, related to prior surgery or trauma. Surgical scars, keloids, hypertrophic scarring, or prior facial paralysis are also noted.
Eyelid Function Assessment
- Eyelid function examination assesses upper and lower eyelid function, including voluntary and involuntary blinking. Lagophthalmos (incomplete eyelid closure) jeopardizes the cornea, so corneal sensation is crucial. Examining medial and lateral canthi laxity helps evaluate ectropion (lower eyelid retraction). The snap or distraction test assesses lower eyelid laxity. The lower lid's normal apposition to the globe ensures proper tear-pumping mechanism (lacrimal punctum contact with lacrimal lake). Lid retraction leads to epiphora (excess tearing) and dry eye symptoms. Lagophthalmos risks exposure keratitis and corneal ulceration. The globe-orbital rim vector (negative vector = globe anterior to orbital rim) affects treatment strategy and risk of ectropion. Proptosis (prominent eyes) also impacts treatment.
Facial Nerve Grading Systems
- Several systems assess facial nerve function. The House-Brackmann Facial Grading System (HBFGS) rates facial motor function on a 6-point scale (I = normal, VI = total paralysis). The Sunnybrook Facial Grading System (SFGS) considers resting symmetry, voluntary muscle excursion, and synkinesis for a composite score. The SFGS is highly reliable, sensitive to recovery over time and is now considered the standard. The revised HBFGS (version 2.0) satisfies most criteria but lacks intraobserver reliability. A review (Fattah et al. 2015) identified 19 facial nerve grading instruments and concluded SFGS as the current standard.
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Description
This quiz covers the assessment of facial nerve dysfunction, focusing on facial shape, structure, and eyelid function. It includes evaluations of contour deformities, surgical scars, and eyelid closure mechanisms. Understanding these assessments is essential for diagnosing facial nerve issues and ensuring patient care.
