Facial Weakness
How to Elicit
- Ask the patient to raise their eyebrows, close their eyes, puff out their cheeks and then show their teeth. Apply resistance if the movement appears to be weak.
Interpretation
- Facial weakness without eyebrow droop (central palsy) - suggests an upper motor neuron lesion
- Facial weakness with eyebrow droop - suggests a facial nerve (VII) lesion
Causes of Facial Weakness
Upper Motor Neuron Lesion
- Ischaemia
- Haemorrhage
- Tumour
- Trauma
Lower Motor Neuron (Facial Nerve) Lesion
- Bell's Palsy
- Herpes Zoster (Ramsay-Hunt syndrome)
- Tumour
- Skull Fracture
Extra Credit
Muscles of Facial Movement
- Eyebrow elevation - frontalis, occipitalis
- Eyebrow depression - procerus
- Eye closing - orbicularis oculi
- Puffing cheeks - orbicularis oris, buccinator
- Showing teeth - platysma, risorius, zygomaticus major & minor, levator labii, levator anguli oris, depressor anguli oris
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