facial assymetries

Question 1

expected palpebral aperture

Answer 1

10-12 mm

Question 2

UL of palpebral aperture should be?

Answer 2

2 mm below superior limbus

Question 3

LL of palpebral aperture should be?

Answer 3

1 mm above inferior limbus

Question 4

OD and OS for exophthalmometry should be

Answer 4

+/- 1.0 mm

Question 5

exophthalmometry in european americans

Answer 5

15-20 mm

Question 6

exophthalmometry in african americans

Answer 6

up to 24 mm

Question 7

exophthalmometry in asians compared to whites

Answer 7

3 mm less

Question 8

muscles of facial expression, superficial muscles of upper and or lower face

Answer 8

facial palsy and facial nerve

Question 9

limited to adnexa, one eye sunken, protruding, apparent difference in eye size

Answer 9

assymetry of the palpebral aperture;

TRO and orbital disease

Question 10

true ptosis, anisocoria

Answer 10

anisocoria/ptosis

Question 11

how to check muscles of facial expression?

Answer 11

facial nerve (CN 7)
1. whole face --> look at the patient's face: check for any asymmetry

1. distinguish upper face from lower face
2. is the asymmetry limited to lower face only, or both?

Question 12

forehead, eyebrows, orbicularis oculi

Answer 12

upper

Question 13

orbicularis oris, cheeks, orbicularis oculi

Answer 13

lower

Question 14

does the boundary between uper and lower face vary among people?

Answer 14

yes

Question 15

Tell pt. to raise his eyebrows as if he is surprised. Dr. checks for symmetry of eyebrows and pattern of wrinkles on the forehead

b. Same instruction but Dr. pushes down on eyebrows: checks for symmetry of strength
c. Tell pt. to close his eyes tightly. Dr. checks for symmetry.
d. Same instructions as #3 but Dr. pries the eyes open: checks for symmetry of resistance

Answer 15

how to check upper division of cn 7

Question 16

a. Tell pt. to blow out or puff out his cheeks. Dr. checks for symmetry.
b. Tell pt. to smile, or turn up the corners of his mouth. Dr. checks for symmetry.
c. Tell pt. to frown, or turn down the corners of his mouth. Dr. checks for symmetry.
d. LOOK at the naso-labial fold. Dr. checks for symmetry.

Answer 16

how to check for lower division of cn 7

Question 17

1. One eye higher (or lower) than the other
2. Lumps, bumps, esp. big ones, around
   the eyes
3. Exophthalmos (proptosis, globe pushed forward within orbit)
4. Enophthalmos (retraction of the globe into the orbit)
5. Apparent difference in eye size

Answer 17

facial asymmetries observed in the adnexa

Question 18

1. ptosis
2. pseudoptosis
3. lid retraction
4. exophthalmos
5. enophthalmos

Answer 18

5 facial asymmetries of the palpebral aperture

Question 19

eyelid drooping

Answer 19

ptosis

Question 20

apparent, not real

Answer 20

pseudoptosis

Question 21

lid pulled up too far

Answer 21

lid retraction

Question 22

proptosis, globe pushed forward within orbit

Answer 22

exophthalmos

Question 23

retraction of the globe into the orbit

Answer 23

enophthalmos

Question 24

If the palpebral apertures are different sizes,

check what?

Answer 24

pupils

Question 25

first steps measuring facial asymmetries - Adnexa, palpebral aperture, pupils

Answer 25

1. Measure the palpebral apertures (lid margin to lid margin).
2. Measure extension of the globe beyond the edges of the orbit.

Question 26

Have the patient return with old pictures, preferably close-ups &/or head shots at least one year old.

Answer 26

family album imaging (FAI)

Question 27

pt presents with facial asymmetry with equal PA and no exophthalmos, what might they have?

Answer 27

pseudoptosis (hypertropia)