After a minor head injury a young patient was unable to close his left eye and had drooling of saliva from left angle of mouth. He is suffering from:
Ans. is 'a' i.e. VII nerve injury [Ref API medicine, 6/e, 730, Dhingra, 3/e p. 123 (2/e, p99) Harrison 17/e p 2584-8516/e p 2436))Inability to close the eye and drooling of saliva from the same side of the mouth is characteristic of VII nerve palsy (U/L)C/F of U/L Facial nerve palsyLower motor neuron (There is loss of muscles of facial expression)Upper motor neuronIpsilateral face is involvedAbsence of furrowing of face on the same sideInability to close the ipsilateral eye (on attempted closure the eyeball rolls upwards- Bell's phenomenon)Flattening of the nasolabial foldsDrooping of the angle of the mouthDeviation of mouth towards opposite side*Contralateral face is involvedThe lower half of the face is involved as in lower motor neuron palsy where as the upper half of the face is spared as it has B/L innervation.* Lets also seeClinical feature of 5th Nerve palsyLoss of corneal reflex*Loss of sensory sensations of face*When one trigeminal N. is paralysed, the jaw deviates to the paralysed side when the pt. attempts opening his mouth (Because of unbalanced action of pterygoid) B/l upper motor neuron lesion of trigeminal N. above the level of pons, causes exaggerated jaw jerk*Clinical feature of 3rd Nerve palsySevere ptosis*Dilated pupil*Divergent squint*Crossed diplopia*
VIIth nerve injury.
Vth nerve injury.
IIIrd nerve injury.
Combined VIIth and IIIrd nerve injury.
Cranial Nerve Disorders