Bell's palsy physical examination: Difference between revisions
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{{Bell's palsy}} | {{Bell's palsy}} | ||
{{CMG}}; {{AE}} {{MMJ}} | |||
==Overview== | |||
Patients with [[Bell's palsy CT|Bell's palsy]] usually appear normal. [[Physical examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually remarkable for: unintended eye closure with an effort to smile, incomplete closure and the of the eye when patient attempts to close the eyes, inability to puff the cheek in affected side and impaired or absent [[taste]] in affected side, reduced [[Hearing|hearing acuity]], [[Tenderness]] upon palpation of the [[ear]], facial tenderness in distribution of [[facial nerve]] and asymmetric smile. [[Facial nerve]] reflexes may be impaired, including: impaired [[orbicularis oculi]] and impaired [[corneal reflex]]. | |||
==Physical Examination== | |||
===Appearance of the Patient=== | |||
*Patients with [[Bell's palsy (patient information)|Bell's palsy]] usually appear normal. | |||
===Vital Signs=== | |||
*[[Vital signs]] in patients with Bell's palsy are usually normal. | |||
===Skin=== | |||
* Skin examination of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===HEENT=== | |||
* Unintended eye closure with an effort to smile<ref name="pmid20879064">{{cite journal| author=Kim J, Lee HR, Jeong JH, Lee WS| title=Features of facial asymmetry following incomplete recovery from facial paralysis. | journal=Yonsei Med J | year= 2010 | volume= 51 | issue= 6 | pages= 943-8 | pmid=20879064 | doi=10.3349/ymj.2010.51.6.943 | pmc=2995977 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20879064 }} </ref> | |||
* Incomplete closure and the of the eye when patient attempts to close the eyes<ref name="pmid17956069">{{cite journal| author=Tiemstra JD, Khatkhate N| title=Bell's palsy: diagnosis and management. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 997-1002 | pmid=17956069 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956069 }} </ref> | |||
* Inability to puff the cheek in affected side<ref name="pmid25685117">{{cite journal| author=Ng SY, Chu MH| title=Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases. | journal=J Chiropr Med | year= 2014 | volume= 13 | issue= 2 | pages= 96-103 | pmid=25685117 | doi=10.1016/j.jcm.2014.06.010 | pmc=4322014 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25685117 }} </ref> | |||
* Impaired or absent [[taste]] in affected side<ref name="pmid1443087">{{cite journal| author=Merren MD| title=Case 1: Bell's palsy and persistent loss of taste. Case 2: Bell's palsy, dramatic recovery with high dose steroid therapy. | journal=Am J Otol | year= 1992 | volume= 13 | issue= 5 | pages= 488 | pmid=1443087 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1443087 }} </ref> | |||
* [[Facial nerve]] reflexes may be impaired, including: | |||
** Impaired [[orbicularis oculi]] (blink) reflex (gentle finger percussion of the [[glabella]] while observing for involuntary [[blinking]] with each stimulus. The [[efferent]] response of this reflex is carried by the [[facial nerve]]) <ref name="pmid4722478">{{cite journal| author=Marinacci AA| title=Orbicularis oculi (blink) reflex in Bell's palsy. | journal=Bull Los Angeles Neurol Soc | year= 1973 | volume= 38 | issue= 3 | pages= 126-37 | pmid=4722478 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4722478 }} </ref> | |||
** Impaired [[corneal reflex]] <ref name="pmid20386632">{{cite journal| author=Sanders RD| title=The Trigeminal (V) and Facial (VII) Cranial Nerves: Head and Face Sensation and Movement. | journal=Psychiatry (Edgmont) | year= 2010 | volume= 7 | issue= 1 | pages= 13-6 | pmid=20386632 | doi= | pmc=2848459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20386632 }} </ref> | |||
* [[Tenderness]] upon palpation of the [[ear]] may be present.<ref name="pmid19932939">{{cite journal| author=Han DG| title=Pain around the ear in Bell's palsy is referred pain of facial nerve origin: the role of nervi nervorum. | journal=Med Hypotheses | year= 2010 | volume= 74 | issue= 2 | pages= 235-6 | pmid=19932939 | doi=10.1016/j.mehy.2009.06.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932939 }} </ref> | |||
*[[Facial-nerve palsy|Facial tenderness]] in distribution of [[facial nerve]]<ref name="pmid25544960">{{cite journal| author=De Seta D, Mancini P, Minni A, Prosperini L, De Seta E, Attanasio G et al.| title=Bell's palsy: symptoms preceding and accompanying the facial paresis. | journal=ScientificWorldJournal | year= 2014 | volume= 2014 | issue= | pages= 801971 | pmid=25544960 | doi=10.1155/2014/801971 | pmc=4270115 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25544960 }} </ref> | |||
* [[Hearing|Hearing acuity]] may be reduced(because of impairment of the function of [[Stapedius|stapedius muscle]]).<ref name="pmid8444335">{{cite journal| author=Margolis RH| title=Detection of hearing impairment with the acoustic stapedius reflex. | journal=Ear Hear | year= 1993 | volume= 14 | issue= 1 | pages= 3-10 | pmid=8444335 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8444335 }} </ref> | |||
* [[Wrinkle|Wrinkling]] of the [[forehead]] when raising the [[eyebrows]] is asymmetric or absent on the affected side.<ref name="pmid21747074">{{cite journal| author=Sajadi MM, Sajadi MR, Tabatabaie SM| title=The history of facial palsy and spasm: Hippocrates to Razi. | journal=Neurology | year= 2011 | volume= 77 | issue= 2 | pages= 174-8 | pmid=21747074 | doi=10.1212/WNL.0b013e3182242d23 | pmc=3140075 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21747074 }} </ref> | |||
* Asymmetric smile<ref name="pmid20879064">{{cite journal| author=Kim J, Lee HR, Jeong JH, Lee WS| title=Features of facial asymmetry following incomplete recovery from facial paralysis. | journal=Yonsei Med J | year= 2010 | volume= 51 | issue= 6 | pages= 943-8 | pmid=20879064 | doi=10.3349/ymj.2010.51.6.943 | pmc=2995977 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20879064 }} </ref> | |||
* [[Nystagmus]] is not a feature of bell's palsy and it could help to differentiate [[Bell's palsy (patient information)|Bell's palsy]] from [[Ramsay-Hunt syndrome|Ramsay Hunt syndrome]](witch may have [[nystagmus]]) | |||
* Extra-ocular movements are normal. | |||
*[[Weber test]] is usually normal. | |||
*[[Rinne test]] is usually normal. | |||
* [[Ear canal]] is usually normal. | |||
*[[Ophthalmic artery|Ophthalmoscopic]] exam is usually normal. | |||
* [[Pupil|Pupils]] examination is usually normal. | |||
===Neck=== | |||
* Neck [[examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Lungs=== | |||
*[[Pulmonary examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Heart=== | |||
*[[Cardiovascular|Cardiovascular examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Abdomen=== | |||
*[[Abdominal examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Back=== | |||
*[[Baba Raghav Das Medical College|Back examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Genitourinary=== | |||
*[[Genitourinary organs|Genitourinary examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
===Neuromuscular=== | |||
*Patient is usually oriented to persons, place, and time. | |||
* [[Glasgow coma scale]] is usually 15. | |||
* [[Plantar reflex|Babinski reflex]] is usually normal. | |||
* [[Muscle rigidity]] is usually normal. | |||
*Upper and lower extremity [[Tone (linguistics)|tone]] is usually normal. | |||
*[[Sensation]] in the upper and lower extremity is usually normal. | |||
*[[Straight leg raise|Straight leg raise test]] is usually normal. | |||
*[[Gait]] is usually normal. | |||
*[[Finger agnosia|Finger-to-nose test]] is usually normal. | |||
*[[Palmar|Palm]] [[Tapas Acupressure Technique|tapping test]] is usually normal. | |||
===Extremities=== | |||
*[[Extremities|Extremities examination]] of patients with [[Bell's palsy (patient information)|Bell's palsy]] is usually normal. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | {{WH}} | ||
{{WS}} | |||
[[Category: (name of the system)]] | |||
Latest revision as of 14:52, 9 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Patients with Bell's palsy usually appear normal. Physical examination of patients with Bell's palsy is usually remarkable for: unintended eye closure with an effort to smile, incomplete closure and the of the eye when patient attempts to close the eyes, inability to puff the cheek in affected side and impaired or absent taste in affected side, reduced hearing acuity, Tenderness upon palpation of the ear, facial tenderness in distribution of facial nerve and asymmetric smile. Facial nerve reflexes may be impaired, including: impaired orbicularis oculi and impaired corneal reflex.
Physical Examination
Appearance of the Patient
- Patients with Bell's palsy usually appear normal.
Vital Signs
- Vital signs in patients with Bell's palsy are usually normal.
Skin
- Skin examination of patients with Bell's palsy is usually normal.
HEENT
- Unintended eye closure with an effort to smile[1]
- Incomplete closure and the of the eye when patient attempts to close the eyes[2]
- Inability to puff the cheek in affected side[3]
- Impaired or absent taste in affected side[4]
- Facial nerve reflexes may be impaired, including:
- Impaired orbicularis oculi (blink) reflex (gentle finger percussion of the glabella while observing for involuntary blinking with each stimulus. The efferent response of this reflex is carried by the facial nerve) [5]
- Impaired corneal reflex [6]
- Tenderness upon palpation of the ear may be present.[7]
- Facial tenderness in distribution of facial nerve[8]
- Hearing acuity may be reduced(because of impairment of the function of stapedius muscle).[9]
- Wrinkling of the forehead when raising the eyebrows is asymmetric or absent on the affected side.[10]
- Asymmetric smile[1]
- Nystagmus is not a feature of bell's palsy and it could help to differentiate Bell's palsy from Ramsay Hunt syndrome(witch may have nystagmus)
- Extra-ocular movements are normal.
- Weber test is usually normal.
- Rinne test is usually normal.
- Ear canal is usually normal.
- Ophthalmoscopic exam is usually normal.
- Pupils examination is usually normal.
Neck
- Neck examination of patients with Bell's palsy is usually normal.
Lungs
- Pulmonary examination of patients with Bell's palsy is usually normal.
Heart
- Cardiovascular examination of patients with Bell's palsy is usually normal.
Abdomen
- Abdominal examination of patients with Bell's palsy is usually normal.
Back
- Back examination of patients with Bell's palsy is usually normal.
Genitourinary
- Genitourinary examination of patients with Bell's palsy is usually normal.
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- Glasgow coma scale is usually 15.
- Babinski reflex is usually normal.
- Muscle rigidity is usually normal.
- Upper and lower extremity tone is usually normal.
- Sensation in the upper and lower extremity is usually normal.
- Straight leg raise test is usually normal.
- Gait is usually normal.
- Finger-to-nose test is usually normal.
- Palm tapping test is usually normal.
Extremities
- Extremities examination of patients with Bell's palsy is usually normal.
References
- ↑ 1.0 1.1 Kim J, Lee HR, Jeong JH, Lee WS (2010). "Features of facial asymmetry following incomplete recovery from facial paralysis". Yonsei Med J. 51 (6): 943–8. doi:10.3349/ymj.2010.51.6.943. PMC 2995977. PMID 20879064.
- ↑ Tiemstra JD, Khatkhate N (2007). "Bell's palsy: diagnosis and management". Am Fam Physician. 76 (7): 997–1002. PMID 17956069.
- ↑ Ng SY, Chu MH (2014). "Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases". J Chiropr Med. 13 (2): 96–103. doi:10.1016/j.jcm.2014.06.010. PMC 4322014. PMID 25685117.
- ↑ Merren MD (1992). "Case 1: Bell's palsy and persistent loss of taste. Case 2: Bell's palsy, dramatic recovery with high dose steroid therapy". Am J Otol. 13 (5): 488. PMID 1443087.
- ↑ Marinacci AA (1973). "Orbicularis oculi (blink) reflex in Bell's palsy". Bull Los Angeles Neurol Soc. 38 (3): 126–37. PMID 4722478.
- ↑ Sanders RD (2010). "The Trigeminal (V) and Facial (VII) Cranial Nerves: Head and Face Sensation and Movement". Psychiatry (Edgmont). 7 (1): 13–6. PMC 2848459. PMID 20386632.
- ↑ Han DG (2010). "Pain around the ear in Bell's palsy is referred pain of facial nerve origin: the role of nervi nervorum". Med Hypotheses. 74 (2): 235–6. doi:10.1016/j.mehy.2009.06.027. PMID 19932939.
- ↑ De Seta D, Mancini P, Minni A, Prosperini L, De Seta E, Attanasio G; et al. (2014). "Bell's palsy: symptoms preceding and accompanying the facial paresis". ScientificWorldJournal. 2014: 801971. doi:10.1155/2014/801971. PMC 4270115. PMID 25544960.
- ↑ Margolis RH (1993). "Detection of hearing impairment with the acoustic stapedius reflex". Ear Hear. 14 (1): 3–10. PMID 8444335.
- ↑ Sajadi MM, Sajadi MR, Tabatabaie SM (2011). "The history of facial palsy and spasm: Hippocrates to Razi". Neurology. 77 (2): 174–8. doi:10.1212/WNL.0b013e3182242d23. PMC 3140075. PMID 21747074.