Facial Asymmetries - overview and classi_Dr. Kurtz

Question 1

What are the normal exophthalmometry of the different ethnicities ranking from largest to smallest?

Answer 1

Blacks - up to 24mm
Whites - 15-20
Asians - 3mm less than whites

Question 2

What are the 3 main categories of disorders presenting with facial asymmetry?

Answer 2

1. muscles of facial expression (superficial muscles of upper and/lower face)
2. limited to the adnexa (one eye sunken or protruding. apparent difference in eye size)
3. True ptosis, anisocoria

Question 3

What structures are included in the upper part of the face, and how do the doctor check if they are working or not?

Answer 3

forehead, eyebrows, orbicularis oculi

1. ask pt to raise the forehead to check forehead symmetry of eyebrows and pattern of wrinkles then push down on the eyebrows.
2. tell pt to close eyes tightly and doctor tries to pry them open. look for asymmetry.

Question 4

What are the structures of the lower part of the face?

Answer 4

orbicularis oris, cheeks and orbicularis oculi

Question 5

How do you check if the lower facial muscles are working?

Answer 5

tell pt to blow out/puff out cheeks
tell pt to smile
tell pt to frown
look at the naso-labial fold (crease on the sides of the mouth)

Question 6

What are the normal palpebral aperture sizes?

Answer 6

10-12 mm
upper lid with 2mm below superior limbus
lower lid with 1mm above inferior limbus