FACIAL WEAKNESS (FACIAL NERVE [VII])
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Look for hemifacial weakness that includes muscles of forehead and orbicularis oculi (see Fig. 187-2). If lesion is in middle ear portion, taste is lost over the anterior two-thirds of tongue and there may be hyperacusis; if lesion is at internal auditory meatus, there may be involvement of auditory and vestibular nerves; pontine lesions usually affect abducens (sixth cranial) nerve and often corticospinal tract. Peripheral nerve lesions with incomplete recovery may produce continuous contractions of affected musculature (facial myokymia); contraction of all facial muscles on attempts to move one group selectively (synkinesis); hemifacial spasms; or anomalous tears when facial muscles activated as in eating (crocodile tears).