Facial Asymmetries - Overview

Question 1

3 main categories of disorders presenting w facial asymmetry

Answer 1

1. Facial palsy
2. Asymmetry of papebral aperture
3. Ptosis/Anisocoria

Question 2

Where is pathology if pt presents w anisocoria without a ptosis =

Answer 2

Pathology in ciliary ganglion or peripheral

Question 3

Anisocoria/ptosis -

Answer 3

• True ptosis

- Anisocoria

Question 4

Asymmetry of palpebral aperture (TRO, orbital disease) -

Answer 4

• Adnexa
• One eye sunken or protruding
• Apparent differ in eye size

Question 5

Exophthalmometry in AA:

Answer 5

Up to 24 mm

Question 6

Exophthalmometry in Europeans:

Answer 6

15-20 mm

Question 7

Exophthalmometry size =

Answer 7

+/- 1 mm

Question 8

Facial asymmetries observed in adnexa

Answer 8

• One eye higher
• Lumps, bumps
• Differ in eye size
• Exophthalmos
• Enophthalmos

Question 9

Facial asymmetries of palpebral adnexa

Answer 9

• Ptosis
• Pseudoptosis
• Lid retraction
• Exophthalmos
• Enophthalmos

Question 10

Facial palsy (CN 7) -

Answer 10

• Muscles of facial expression

- Superficial muscles of upper/lower face

Question 11

Lower face muscles:

Answer 11

1. Cheeks (blow out/puff)
2. Obicularis oris (smile, frown, naso-labial fold)
3. Obicularis oculi

Question 12

Lower lid is ___ inferior limbus

Answer 12

1 mm above

Question 13

Palpebral aperture size:

Answer 13

10-12 mm

Question 14

Where is pathology if pt presents w ptosis without anisocoria =

Answer 14

Pathology in orbit or neuromuscular junction

Question 15

T/F: In exophthalmometry, asians are about 3 mm less than Caucasians

Answer 15

T

Question 16

Techniques for working up pt presenting w facial asymmetries:

Answer 16

1. Measure palpebral apertures (lid to lid)
2. Exophthalmometry
3. Have pt bring in old photos (FAI - family imaging album)

Question 17

Where is pathology if pt presents w unequal apertures and anisocoria =

Answer 17

Pathology para/sym

Question 18

Upper face muscles:

Answer 18

1. Eyebrows (raise, push down)
2. Forehead (wrinkles)
3. Orbicularis oculi (close eyes, pry eyes open - easy if palsy present)

Question 19

Upper lid is ___ superior limbus

Answer 19

2 mm below

Question 20

If palpebral aperturs are differ sizes, check ___

Answer 20

Pupils

Levator and iris sphincter follow same pahtway for most of course