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Speech Exam

Facial Inspection


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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