Facial Nerve Palsy: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes and sclerae (white part of the eye).
    • Inspection of the face in its overall symmetry.
      • [central (supranuclear) lesion of the VII cranial nerve → disturbance of the perioral (“around the mouth”) musculature in its function
      • Peripheral (infranuclear) lesion → paresis (paralysis) of the entire contralateral (on the opposite side) side of the face
      • Nuclear lesion in the brainstem itself = central lesion with the clinical appearance of a peripheral lesion]

      After a general examination of the face, the individual facial branches must be inspected:

      • [Checking the eye closure (“signe de ciles”; “cilia sign” is the term used to describe the eyelashes remaining visible when the eyelids are incompletely closed or weakly closed) or the so-called “bark phenomenon” (in this case, incomplete eye closure reveals an eye bulb that moves upwards)]
      • Assessment of the nasolabial fold [smear nasolabial fold].
      • Assessment of the position of the mouth. The patient must mimic the following prompts: Frowning, forced eye closure, nose wrinkling, teeth showing, whistling, forming a kissing mouth, and mouth puffing.
  • Ophthalmological examination – if corneal ulcer is suspected.
  • ENT medical examination – examination of the ears including otoscopy (otoscopy), parotid gland and mastoid; if damage to the ear is suspected.
  • Neurological examination – including testing of reflexes, consciousness, motor function and sensitivity; examination of the n. fascialis (VII cranial nerve) and the n. abducens (VI cranial nerve), which originates in the immediate vicinity of the n. fascialis in the brain stem.

Square brackets [ ] indicate possible pathological (pathological) physical findings.