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Cranial Nerves

Facial Inspection

February 15th, 2021

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.


  • 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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