Encyclopedia of Ayurvedic Medicinal Plants

Testing the motor functions:

 [Muscles of mastication -Temporalis, Masseter, Lateral & medial Pterygoid and Tensor velli palatani]

Ask the patient to clench his teeth: the temporal and masseter muscles should stand out with equal prominence on both sides This can be better checked by palpation over the muscles if there is paralysis on one side. the muscles on that side will fail to become prominent. Now ask the subject to open his mouth. The jawwill deviate towards the paralysed side, being pushed over by the healthy lateral pterygoid muscles.

Elicit the corneal reflex, Conjunctival reflex and jaw jerk (Refer page no 133 and 135)

VII. Facial Nerve has both sensory and motor components. Test for sensory functions:

Taste sensation: on the anterior two thirds of the tongue is tested. Strong solutions of sugar (sweet) and common salt (salt) and weak solution of citric acid (sour) and quinine( bitter) are used for this. Before doing the test tell the subject the details of the test. The solution is applied to the protruded tongue using a wooden rod. Ask the subject to write down in a paper the taste he gets, before he withdraws the tongue. Mouth is washed and test is repeated with other substances also. use quinine only last as its bitter taste lasts longer.

Ask for any hallucinations of taste as it occurs in the aura of epilepsy.

Ageusia - absence of taste sensation.

Test tor motor functions: [Muscles of facial expression - Anterio belly of Occipita frontalis, Orbicularis oculi, Orbicularis oris, buccinator, Depressor anguli oris and Platysma]

Variousfacial musclessupplied byfacial nervearetested asfollows:

1. Ask the subject to wrinkle his forehead by raising the eyebrows. Compare the wrinkles on

both sides. It will be less prominent or absent on the affected side.

2. Ask the subject to shut his eyes as tightly as he can. The examiner tries to open it. On the

affected side, the subject cannot close his eyes tightly or the examiner can easily open it.

3. Compare the nasolabial folds on both sides. It is less prominent on the affected side.

4. Ask the subject to smile showing his teeth. When the facial nerve is affected on one side, the angle of

mouth is deviated to the opposite side.

5. Ask the subject to inflate both cheeks. Gently tap on the cheek with the finger. Air easily escapes from

the affected side.

6. Ask the subject to whistle. If facial nerve is involved he is unable to do so.

Discussion:

In upper motor neuron (supranuclear lesion) type of facial paralysis, lower part of face is mainly affected. (Upper part of the face is spared because of bilateral innervation). In lower motor neuron (nuclear or infranuclear lesion) type of facial paralysis, upper and lower parts of the face are affected. Bell’s sign can also be seen in LMN facial paralysis i.e. upward rolling of the eye ball while attempting to close the eyes.

When the lesion is inside the facial canal the chorda tympani branch is affected causing impaired taste sensation in anterior two third of tongue. The nerve to stapedius if involved hyperacusis on the affected side occurs.

VIII. Vestibulo Cochlear Nerve:

Cochlear part:

Tests of hearing:

1. Watch test: Stand behind the subject and ask him to close his eyes and the ear which is not being tested. Bring a ticking watch from a distance to the ear to be tested and ask him to say ‘yes’ when he hears the tick sound. Repeat on the other ear and compare. Impairment of hearing can occur due to block in the external auditory canal.

2. Tuning fork tests: The most widely used forks are vibrating at 256 or 512 Hz.

Rinne’s test: By this we compare the hearing by air conduction and bone conduction of sound. Make the tuning fork vibrate and place its base firmly on the mastoid process. Subject is asked to indicate by showing one finger as soon as he starts hearing the sound and by two fingers as he ceases to hear the sound, then the vibrating prongs of the tuning fork are quickly brought close to the ear. Ask the subject to indicate by one finger if he can still hear the sound and two fingers if he cannot. If the patient still hears the sound, the test is Rinne positive (Normal), i.e. Air conduction is better than bone conduction.