Bell's palsy physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Patients with Bell’s palsy usually appear normal. Physical examination of patients with Bell’s palsy is usually remarkable for: unintended eye closure with an effort to smile, incomplete closure and the of the eye when patient attempts to close the eyes, inability to puff the cheek in affected side and impaired or absent taste in affected side, reduced hearing acuity, Tenderness upon palpation of the ear, facial tenderness in distribution of facial nerve and asymmetric smile. Facial nerve reflexes may be impaired, including: impaired orbicularis oculi and impaired corneal reflex.

• Patients with Bell’s palsy usually appear normal.

• Vital signs in patients with Bell’s palsy are usually normal.

• Skin examination of patients with Bell’s palsy is usually normal.

• Unintended eye closure with an effort to smile^[1]
• Incomplete closure and the of the eye when patient attempts to close the eyes^[2]
• Inability to puff the cheek in affected side^[3]
• Impaired or absent taste in affected side^[4]
• Facial nerve reflexes may be impaired, including:
  • Impaired orbicularis oculi (blink) reflex (gentle finger percussion of the glabella while observing for involuntary blinking with each stimulus. The efferent response of this reflex is carried by the facial nerve) ^[5]
  • Impaired corneal reflex ^[6]
• Tenderness upon palpation of the ear may be present.^[7]
• Facial tenderness in distribution of facial nerve^[8]
• Hearing acuity may be reduced(because of impairment of the function of stapedius muscle).^[9]
• Wrinkling of the forehead when raising the eyebrows is asymmetric or absent on the affected side.^[10]
• Asymmetric smile^[1]

• Nystagmus is not a feature of bell’s palsy and it could help to differentiate Bell’s palsy from Ramsay Hunt syndrome(witch may have nystagmus)
• Extra-ocular movements are normal.
• Weber test is usually normal.
• Rinne test is usually normal.
• Ear canal is usually normal.
• Ophthalmoscopic exam is usually normal.
• Pupils examination is usually normal.

• Neck examination of patients with Bell’s palsy is usually normal.

• Pulmonary examination of patients with Bell’s palsy is usually normal.

• Cardiovascular examination of patients with Bell’s palsy is usually normal.

• Abdominal examination of patients with Bell’s palsy is usually normal.

• Back examination of patients with Bell’s palsy is usually normal.

• Genitourinary examination of patients with Bell’s palsy is usually normal.

• Patient is usually oriented to persons, place, and time.
• Glasgow coma scale is usually 15.
• Babinski reflex is usually normal.
• Muscle rigidity is usually normal.
• Upper and lower extremity tone is usually normal.
• Sensation in the upper and lower extremity is usually normal.
• Straight leg raise test is usually normal.
• Gait is usually normal.
• Finger-to-nose test is usually normal.
• Palm tapping test is usually normal.

• Extremities examination of patients with Bell’s palsy is usually normal.

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