CLINICAL DIAGNOSTIC MANUAL
Loss of sensation in the face, medically known as facial hypoesthesia, can result from various conditions affecting the nerve pathways responsible for facial sensitivity. These pathways include the branches of the trigeminal nerve (cranial nerve V), which divides into three main branches: ophthalmic, maxillary, and mandibular.
The involvement of any of these branches can lead to decreased or complete loss of sensation in the specific areas of the face they innervate. A detailed clinical evaluation is crucial to identify the underlying cause and plan appropriate treatment.
Condition | Clinical Symptoms and Signs | Suspected Diagnosis | Confirmatory Diagnosis |
|---|---|---|---|
Ophthalmic branch (V1) lesion | Loss of sensation in the forehead, scalp, and upper nose, absent corneal reflex | Clinical history, focal neurological exam | Brain MRI, nerve conduction studies |
Maxillary branch (V2) lesion | Loss of sensation in the cheek, upper lip, and lower part of the nose | Clinical history, focal neurological exam | Brain MRI, nerve conduction studies |
Mandibular branch (V3) lesion | Loss of sensation in the jaw, lower lip, and lower cheek | Clinical history, focal neurological exam | Brain MRI, nerve conduction studies |
Trigeminal neuralgia | Severe, episodic facial pain in areas innervated by the trigeminal nerve | Clinical history, signs of paroxysmal pain | Brain MRI, neurological evaluation |
Multiple sclerosis | Facial sensation loss with other neurological symptoms (weakness, vision problems) | Clinical history, neurological exam, signs of multifocal involvement | Brain MRI, lumbar puncture |
Brain tumour | Progressive sensation loss, other possible neurological symptoms (headaches, seizures) | Clinical history, focal neurological signs | Brain CT or MRI, biopsy if needed |
Stroke (CVA) | Sudden neurological deficit, facial sensation loss, weakness, difficulty speaking or walking | Clinical history, signs of acute neurological deficit | Brain CT or MRI, cerebral angiography |
Herpes zoster ophthalmicus | Pain and vesicular rash in the ophthalmic nerve distribution, sensation loss | Clinical history, signs of skin eruption | PCR for herpes virus, clinical exam |
Infections (meningitis/encephalitis) | Fever, neck stiffness, altered mental state, facial sensation loss | Clinical history, meningeal and neurological signs | Lumbar puncture, cultures, brain CT or MRI |
Facial or cranial trauma | Sensation loss in the affected nerve distribution, possible fractures | Trauma history, signs of facial or cranial fractures | Cranial CT, ophthalmologist or neurosurgeon evaluation |
Diabetic neuropathy | Facial sensation loss, peripheral neuropathy, signs of hyperglycaemia | Clinical history, physical exam, signs of diabetic neuropathy | Blood glucose tests, HbA1c, neurological evaluation |
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