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Clinical examination

Authoring team

When examining cranial nerve VII, look for facial asymmetry; note if there is bilateral facial nerve palsy then symmetry can be maintained.

Test muscle power:

  • ask the patient to wrinkle his forehead - push down on the corrugation on each side - note that this movement is preserved on the side of an upper motor neurone lesion; this is because there is bilateral cortical representation of these muscles
  • ask the patient to close his eyes and then try to force open each eye
  • ask the patient to grin
  • ask the patient to blow out his or her cheeks
  • if the examiner detects a lower motor neurone lesion then check ears and palate for vesicles of the geniculate ganglion - Ramsay Hunt syndrome

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