Video 29 Bell’s palsy
The patient is unable to raise the right eye brow (frontalis) or screw up the right eye (orbicularis oculi), or smile on the right, or purse his lips on the right (orbicularis oris) or contract the right platysma. When he screws the eyes up, the right eye is seen to roll up (Bell’s sign).
Video 30 Right hemifacial spasm in a patient with prior right Bell’s palsy showing ipsilateral synkinesis of lower facial muscles when he voluntarily contracts right upper facial muscles.
Video 31 Long-standing right facial palsy
Deepened right naso-labial fold; spontaneous blinking stronger on the normal (left) side; right corner of the mouth twitches when he blinks; smiling, pouting or blowing his cheeks out all cause the right eye to close; right cheek blows out less than left (tighter right buccinator). All features of overactivity of surviving axons in the right facial nerve associated with synkinesis (‘cross-talk’ between axons). These signs are not due to contracture of the right facial muscles as they are lost if the nerve is severed by, for example, surgery for acoustic neuroma.
Video 32 Left upper motor neurone facial palsy following stroke
The patient’s face is symmetrical at rest; on being asked to smile, he blinks and closes his eyes (apraxia of smiling) and then fails to elevate the right angle of the mouth fully; later, when amused, he smiles symmetrically.
Video 33 Selective right facial weakness from skin cancer
The right upper lip fails to purse, and the patient is unable to form a seal with his mouth when attempting to blow out his cheeks; he is able to raise his eyebrows and screw up his eyes normally; unable to flare the right nostril. The scar on the right cheek is from previous surgery for squamous cell carcinoma.