Bell's palsy physical examination
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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.