Facial Asymmetry
Look For
- Drooping of one side of the face. Compare the angles of the mouth on both sides. Determine whether the eyebrow is spared on the affected side or not.
Interpretation
- Eyebrow sparing (central palsy) - upper motor neuron lesionIschaemia, haemorrhage, tumour, trauma
- Eyebrow involvement - facial nerve (VII) lesionBell's palsy, herpes zoster (Ramsay-Hunt Syndrome), tumour, skull fracture
Sparing of the eyebrows (i.e. absence of eyebrow droop) distinguishes an upper motor neuron lesion from a lower motor neuron lesion, as the eyebrows receive innervation from both cerebral hemispheres (collateral supply) and the lower face receives only contralateral supply.
Blepharospasm
Look For
- Bilateral involuntary spasm of the eyelid muscles.
Causes of Blepharospasm
- Benign essential blepharospasm
- Facial nerve damage
- Herpes zoster infection
- Stroke
- Brainstem trauma
Facial Spasm
Look For
- Involuntary spasm of the muscles on one or both sides of the face.
Interpretation
- Hemifacial spasm - compression of the facial nerve root in the cerebellopontine angle.
- Bilateral facial spasm - oromandibular dystonia, associated with grinding of the teeth.
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