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.