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CNS Examination in children I VII Cranial Nerve Examination | Facial Nerve Palsy | Pediatrics — Transcript

by Learning Pediatrics · 1,999 words · 355 segments · language en · Watch on YouTube

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0:00[Music]
0:00hello everyone today in this video i
0:03will tell you the details of
0:057th cranial now facial now so today you
0:08will learn function of the facial now
0:11how will you examine for this now
0:13then how will you differentiate
0:15the facial palsy is upper motor neurone
0:18and lower motor neurone then you will
0:21learn level of lesion in umn versus
0:24element
0:25facial pulsy facial nerve is the mixed
0:28cranial nerve mainly its motor function
0:31so the motor function of the facial
0:33nerve is it supplies all the facial
0:35muscle for the facial expression except
0:38levator palpably superioris also supply
0:41the scalp muscle platysma stibedious
0:43muscle stylohyoid and posterior belly of
0:46the digestive muscle
0:48and its sensory function mainly the test
0:51sensation to the anterior two third of
0:53the tongue by its branch coda tympani
0:55and its secretomotor function to the
0:58lacrimal gland by the branch greater
1:01superficial petrosal now and to the
1:03salivary gland by the coda tympani
1:06branch
1:07now how will you assess the seventh
1:09cranial nerve function
1:10so first look at the facial symmetry
1:13when the child is in rest position or
1:16when the child is crying talking to you
1:18or smiling when any asymmetry is there
1:21then ask the child to look up for and
1:24then check the fold and wrinkles over
1:26the forehead
1:27child will not be able to wrinkle on the
1:30affected side in lower motor neurone
1:32facial pulsy
1:34then ask the child to close the eyes
1:37tightly
1:38child cannot close the affected eye
1:41and when child will try to close
1:44forcibly
1:45eyeballs rolls upward exposing the
1:48sclera it is known as bales phenomena
1:51this is the image of an adult who was
1:54having the facial nerve palsy and bale's
1:56phenomena is there
1:58i will share this link if you want to
2:00watch
2:01click this link in my description box
2:04tell the child to show the teeth if the
2:06child is having facial nerve palsy then
2:08the nasolabial fold will be flattened on
2:10the affected side
2:12and the drooping of mouth will occur
2:14also tell the child to blow or whistle
2:17if you find air leaks that means it is
2:20the paralyzed side also we have to tape
2:23the cheek when the child is blowing
2:26to see the air is leak from the
2:29paralyzed side or not
2:31after the assessment of the motor
2:32function we have to assess the test
2:35sensation on the anterior two third of
2:37the tongue
2:38which is supplied by the koda tympani
2:41branch
2:43first we have to tell the child to
2:45protrude the tongue and tongue should be
2:47protruded throughout the assessment
2:51tell the child whenever child is having
2:53the test sensation
2:55child should raise the finger
2:58and normal child perceive the test
3:00sensation within 10 second
3:02and order of the test
3:04we should test a sweet then salt then
3:08soar then the in last bitter test
3:12and
3:13we have to apply the test substance over
3:15the dorsal surface of the tongue at the
3:18junction of anterior and middle two
3:20third of the tongue
3:21we can use the earbud for the applying
3:24the test substance
3:26if the child is having lesion proximal
3:28to the origin of coda tympani it will
3:30lead to the lows of test sensation over
3:33the anterior two third of the tongue
3:35for the assessment of secreto motor
3:38function of the facial now we can
3:40perform the topo diagnostic test example
3:43shimmers test
3:45to compare the lacrimation in both the
3:47eyes
3:48in this we keep the strip of filter
3:50paper in the lower fornix of the both
3:53the eyes
3:54then
3:56amount of the waiting of the strip is
3:58measured
3:59so on the affected side lacrimation will
4:02be decreased
4:03for the assessment of salivation
4:05submandibular salivary flow test can be
4:08performed in topo diagnostic test
4:11then we should perform the corneal
4:12reflex as the efferent of corneal
4:14reflexes trisomy
4:17and efferent is facial now i have
4:19already explained the details of corneal
4:21reflex in my previous video on cranial
4:23nerve examination if the child is having
4:26facial nerve palsy then the blink
4:28response will not occur on the affected
4:31side now the difference between upper
4:33motor neurone and the lower motor
4:34neurone facial nerve palsy
4:37supranuclear lesion in the cortex
4:40internal capsule or brain stem
4:43lead to the upper motor neuron lesion
4:45while the
4:47nuclear and the infra nuclear lesion
4:49will lead to the lower motor neuron
4:52now palsy in upper motor neuron lesion
4:55opposite lower half of the face will be
4:57affected while in the lower motor neuron
4:59lesion same side of the upper and lower
5:02face both will be affected so in this
5:04picture you can see i have divided the
5:06face into the four quadrant into the
5:09right upper lower and left upper lower
5:11part of the face if the child is having
5:14right sided upper motor neuron lesion
5:17then the left lower face will be
5:19affected 4. if the child is having right
5:23sided lower motor neuron lesion then the
5:26right-sided
5:28entire face will be affected one and two
5:31and in left
5:33upper motor neuron lesion
5:35right-sided lower part of the face will
5:38be affected 2 and in left lower motor
5:41neuron lesion
5:43completely left sided ipsilateral side
5:46of the face will be affected 3 and 4.
5:49so in the upper motor neuron lesion
5:51forehead eyebrows eyelid musculature
5:54will be spared so the child will have
5:56the flattened nasolabial fold drooping
5:59of mouth in uml lesion
6:02while the entire face will be affected
6:04in element lesion ipsilaterally so the
6:07loss of wrinkle widened palpable fissure
6:10epiphora bales phenomena flattened
6:13nasolabial fold and drooping of mouth
6:16will occur
6:17ipsilaterally in element lesion upper
6:20part of the face is spared in uml lesion
6:23because supranuclear innervation
6:25is bilateral to the muscle of the
6:28forehead and eyes
6:29but only contralateral to the muscle of
6:32the lower part of the face
6:34in uml lesion there will be no facial
6:37muscle atrophy
6:39while in the element lesion facial
6:41muscle atrophy also occur
6:43in um in lesion voluntary facial
6:46movement will be affected in opposite
6:49lower half of the face
6:50but the emotional facial movements
6:52remain intact
6:54while in the element lesion both
6:56voluntary and the emotional facial
6:58movements will be affected
7:01phenomena will not be present in the uml
7:04lesion while it will be present in the
7:06element lesion corneal reflex will
7:09remain normal in uml lesion while it
7:12will be affected
7:13absent in the element lesion
7:16now clinical approach to the level of
7:19lesion in both upper motor neurone and
7:22the lower motor neuron lesions you can
7:24localize the anatomical level of the
7:27lesion
7:28by the characteristic clinical features
7:30and the associated dysfunctions
7:33first according to the finding of either
7:36upper motor neuron or lower motor
7:38neurone we can differentiate either the
7:40lesion in supranuclear or in the nuclear
7:43or infra nuclear so whenever there is a
7:46lesion in supranuclear
7:48means in the cortex or in the
7:50corticobulba tract through the corona
7:53radiator or internal capsule or cerebral
7:55peduncle or in the upper part of the
7:58pose
7:59will lead to the central facial nerve
8:01policy umn type
8:03whenever lesion is
8:05nuclear or infra nuclear
8:08it will lead to the peripheral facial
8:11nerve palsy element type
8:14now the level of lesion in central
8:16facial nerve pulsey if the lesion in
8:18cortex means the lower one-third of the
8:21contralateral pre-central gyrus in
8:23facial area which control the facial
8:25movements if the lesion is present at
8:27the level of cortex
8:29then the with facial now policy of umn
8:32type child will also have the other
8:35cortical sign
8:36example child may be having the
8:38convulsion or the altered level of
8:40consciousness
8:41etiology you have to suspect according
8:43to the onset and the progression if the
8:45child is having acute or sudden onset
8:48of the facial palsy with the cortical
8:50sign that means child may be having any
8:54infarct or hemorrhage in the cortex
8:56if onset is sub-acute and the disease is
9:00progressive
9:01that means may be exol
9:04intracranial space occupying lesions
9:06example tuberculoma neurocystic circuses
9:09or any other tumor
9:11as we know fiber of the facial area from
9:13pre central gyrus
9:15descend in cortico-bulbatract
9:18goes through corona radiator genome of
9:20internal capsule medial portion of
9:22cerebral padunkal
9:24then descend to the bones so if the
9:27child is having lesion in the corona
9:29radiator
9:31then child will have the
9:32hemiplegia or monoplagia of the
9:35epsilator side of the facial nerve palsy
9:38so if the child is having
9:41right-sided lesion in the brain
9:44then child will have the left-sided
9:46hemiplegia or monoplagia
9:49with left-sided facial neoparsy
9:52but the hemiplegia will not be the danes
9:55in lesion in corona radiata
9:58similar presentation will be there
10:00whenever lesion is present in internal
10:02capsule except hemiplegia will be dense
10:05in
10:06internal capsule lesion
10:09now if the lesion in upper part of the
10:11bones where the fibers are descending in
10:14the cortical pulver tract
10:16then the child will have the
10:19umn type of the facial nerve palsy with
10:22contralateral hemiplegia
10:24now the level of lesion in element type
10:26of the facial nerve pulsey so lesion
10:29either in the nuclear or in the infra
10:31nuclear area will lead to the
10:33element type of facial nerve palsy we
10:35label as a peripheral facial nervosa
10:38so the fiber of the cortical bulbatract
10:41from upper part of the sponge deco said
10:43to converge on the facial nucleus from
10:46the facial nucleus
10:48facial now arise it travels upward
10:50backward and around the
10:52nucleus of the cranial nerve 6.
10:55so whenever there is a lesion in the
10:57facial nucleus
10:59child will have the ipsilateral facial
11:01nerve palsy with the sixth cranial nerve
11:03palsy
11:04also having the contralateral hemiplegia
11:07due to the corticospinal fiber damage
11:10then cranial nerve seven leave the bones
11:12laterally and with the cranial nerve
11:14eighth crosses the cerebellar pontine
11:16angle so whenever lesion at this level
11:19child will have the eighth cranial nerve
11:22palsy also
11:23also the cerebellar signs will be there
11:26so the ipsilateral atexia
11:28will be present whenever lesion is
11:30present at the cerebellum pontine angle
11:33after crossing the cerebellopontine
11:35angle seventh grain will now enter into
11:37the internal acoustic meters from meatus
11:40to the genicular ganglion where it turns
11:43partially and form the first genu and
11:46from first genu greater superficial
11:48petrosal now arrives which supply the
11:50lacrimal grain and now to stapedius
11:52arise at the level of the second genome
11:54we supply the stapedius muscle
11:57and then coda tympani branch arise just
12:00proximal to the stylomestoid foramen we
12:03supply the test sensation to the
12:05anterior two-third of the tongue
12:07then after leaving the stylomastoid
12:09foramen it gives some muscular branches
12:12to the posterior auricular
12:14posterior belly of digestive and
12:16stylohyoid muscle
12:19then facial now enter into the parotid
12:21gland and divide into two main trunks
12:23gigomatico temporal and the cervical
12:26mandibular
12:27tzbmc
12:29temporal gigomatic
12:31buccal mandibular and the cervical
12:33muscular branches to supply the muscle
12:36of the face so if the lesion is present
12:40above the first genome
12:42then child will have the
12:44loss of lacrimation hyperacusis loss of
12:47test sensation to the anterior two-third
12:49of the tongue
12:50and ifc
12:51element type of the facial nerve pulsey
12:54if the lesion is present between the
12:56geniculate ganglion and the second
12:59genome then
13:00child will have the normal lacrimation
13:03hyperacusis will be there loss of test
13:05sensation will be there and the
13:07ipsilateral half of the face will be
13:10affected
13:11if the child is having the lesion after
13:14the origin of now twist ibds then
13:17stipedial reflex will be normal and
13:20electro emission will be normal but the
13:22test sensation will be affected and
13:25whole ipsilateral half of the face will
13:28be affected distal to stylo mastoid
13:30foramen or in the parotid gland then the
13:33lacrimation stapedial reflex and test
13:36sensation to the anterior two third of
13:38the tongue will be normal
13:40only the ipsilateral half of the face
13:42will be
13:43affected
13:45so this is all about the facial now
13:47examination
13:50in next video i will cover the rest of
13:52the cranial now thank you so much

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