Facial Sensation Loss

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