Pearls for assessing sensation of the face and head
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Transcript of Pearls for assessing sensation of the face and head
SENSORY PEARLS OF FACE AND HEAD INNERVATION
FACIAL SENSATION Trigeminal nerve supplies sensation back to a plane that passes
through the external auditory meatus……MOSTLY
FACIAL SENSATION…PART 2 Angle of the Jaw, earlobe and
Parotid gland Greater Auricular nerve Derived from C2-C3
INNERVATION OF THE PINNA AND EXTERNAL AUDITORY MEATUS
Dense traffic pattern CN V
Auriculotemoral nerve carries most of the sensation
CN VII Auricular branch Concha and osterior wall of the
canal CN X Lesser occipital nerve Greater auricular nerve
Not surprising that lots of pain is referred to the ear
REFERRED EAR PAIN
HITZELBERGER’S SIGN
Decreased sensitivity in the concha corresponding to the sensory distribution of the seventh nerve is suggestive of a space-occupying lesion in the internal auditory canal or cerebellopontine angle.
May be the only sensory loss in early acoustic neuroma
ZOSTER OPHTHALMICUS
HUTCHINSON’S SIGN IN ZOSTER OPHALMICUS
Involvement of the nasociliary nerve of the ophthalmic division of the trigeminal nerve
Predicts involvement of the globe
MENTAL NERVE AND MENTAL NEUROPATHY (NUMB CHIN)
MENTAL NEUROPATHY
Never a trivial symptom and should start a search for occult malignancy
These metastases originate most commonly from: cancers of the breast (20-30%), thyroid gland (15%) kidneys (13%) lungs (12%) prostate (10%) gastrointestinal system (9%), and other organs (11-21%)
SCALP SENSATION AND NON-TRIGEMINAL PAIN
GREATER OCCIPITAL NEURALGIA Palpate! Put you hands where
the patient say it hurts Treatment may help migraine
and cluster Yes…there is controversy.
Such is life.