Facial Asymmetries Flashcards
what is included in the upper division of the face?
forehead, eyebrows, orbicularis oculi
what is included in the lower division of the face?
orbicularis oculi, orbicularis oris and cheeks
where is the boundary between the upper and lower divisions of the face?
it varies among people
how do you check the upper division of the face for symmetry?
have patient raise eyebrows and/or close eyes tightly = check for asymmetry in appearance and strength by pushing down or prying eyes open
how do you check the lower division of the face for symmetry?
blow out/puff out cheeks, smile, frown, and look at naso-labial folds
what are some facial asymmetries observed in the adnexa?
one eye is higher than other, lumps/bumps, exophthalmos, enophthalmos, apparent eye size difference
what are some facial symmetries observed in with the palpebral aperture?
ptosis, pseudoptosis, lid retraction, exophthalmos and enophthalmos
what do you do to determine if the ptosis is neuro vs. non-neuro?
check the pupils
what are the 3 steps taken if a patient has a facial asymmetry?
- measure palpebral apertures with PD ruler
- measure extension of the globe with exophthalmometry
- have patient return with old photos (family album imaging or FAI)
what is the normal palpebral aperture size?
10-12mm
where is the normal location of the upper lid?
2mm below the superior limbus
where is the normal location of the lower lid?
1mm above the inferior limbus
how much difference is normal between OD and OS in exophthalmometry?
+/- 1 mm (more than 2mm is abnormal)
what is the normal exophthalmometry measurement in European americans?
15-20 mm
what is the normal exophthalmometry measurement in African Americans?
up to 24 mm