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Facial Sensation Loss

Updated: Sep 20

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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