Clinical study of the patient: facial expression

During the general examination of the patient, the doctor must first pay attention to the exposed parts of the patient's body - the head, face, neck.

Variations in size and shape play a special role in the diagnosis. A significant increase in the size of the skull is characteristic of a disease known as headache. If the head is characterized by an excessively small size (microcephaly), it can be concluded that mental underdevelopment. If the head is square, flattened from above, and the frontal bumps are noticeably prominent, then a diagnosis will show congenital syphilis or rickets. The position of the head is also taken into account for the diagnosis of cervical myositis or spondylarthritis. Patients with Parkinson's disease are characterized by frequent involuntary movements of the head (small shaking). Pulsation of the head occurs when aortic valve insufficiency (a symptom of Musset). If there are scars on the head, the doctor should receive additional tips for diagnosis. In particular, he has the opportunity to find out whether the patient has dizziness that occurs in the presence of Meniere's symptom complex or epileptiform seizures.

The facial expression of the patient, in addition to a number of pathological mental and somatic conditions, is greatly influenced by such characteristics as age and gender. A certain diagnostic value has feminine facial features in men and courageous - in women (associated with certain endocrine disorders), as well as some changes in the face.

1. Puffy face is observed:

a) as a result of general edema associated with kidney disease;

b) with local venous stagnation as a result of frequent attacks of choking and coughing;

c) in case of compression of the lymphatic pathways associated with significant effusions in the pleura and pericardium, with tumors of the mediastinum, increasing the size of mediastinal lymph nodes, adhesive mediastinopericarditis, squeezing the superior vena cava (Stokes collar disease).

2. The so-called "Face of Corvizar" indicates heart failure. The face has an edematous appearance, a yellowish-pale color, with a bluish tinge. The mouth is half open all the time, the lips are cyanotic, the eyes constantly stick together, they look dull and pale.

3. The febrile face (facies febrilis) - has such signs as skin flushing, bright eyes, his excited expression. In the case of a number of infectious diseases, it has certain features: in croupous pneumonia, the feverish blush is more pronounced on the side where inflammation occurs in the lungs. In the case of typhus, the general hyperemia of the puffy face is fixed, the sclera of the eye is injected (the sign "rabbit eyes", according to FG Yanovsky). In turn, in typhoid fever, the sclera of the eyes have a slightly jaundiced tint. In patients with tuberculosis with fever, attention is attracted by the "burning eyes" on the emaciated and pale face with a small blush on the cheeks. As for septic fever, the face is characterized by low mobility, pallor, sometimes with a slight yellowness.

Patient's face with acromegaly:

acromegaly

4. Facial features and expression vary noticeably with a number of endocrine disorders:

a) acromegalic face is characterized by an increase in prominent parts (nose, chin, cheekbones), as well as hands, which is associated with acromegaly and is sometimes fixed in certain women during the gestation period;

b) a myxedema person can talk about a decrease in thyroid function. Such a face looks swollen, with obvious mucous edema, the palpebral fissures are reduced, the general contours of the face are smoothed, there is no hair on the outer parts of the eyebrows, and because of a blush on a pale background, the patient’s face is somewhat similar to the doll’s face;

c) facies basedovica - the patient's face associated with hyperfunction of the thyroid gland looks mobile, the eye slits are enlarged, the eyes are brighter, obviously the eyeglass due to which the face takes on a frightened expression;

d) a strongly red, moon-shaped, glossy face; with Itsenko-Cushing's disease in women is complemented by the development of a beard and mustache.

5. The “lion face” is distinguished by a tubercular-knotted thickening of the skin under the eyes and above the eyebrows, an enlarged nose, which is characteristic of leprosy.

6. "Parkinson's mask" - the face is motionless, characteristic of encephalitis.

7. The face of the "wax doll" - looks a bit puffy, extremely pale with a yellowish tinge, the skin appears to be translucent from the inside. Peculiar to patients with anemia of Addison - Birmera.

8. Risus sardonicus - sardonic laughter, mouth widened, as if laughing, numerous folds on the forehead, as in sadness. Characteristic for patients with tetanus.

9. The face of Hippocratic (facies Hyppocratica) —the face has been altered due to collapse in chronic diseases of the abdominal organs (in particular, such diseases as peritonitis, perforation of gastric or duodenal ulcers, gallbladder rupture). For the first time, these signs were described by Hippocrates: sunken eyes, pointed nose, skin looks deathly pale with a bluish tinge, sometimes covered with large drops of cold sweat.

10. Asymmetry of movements of the muscles of the face, associated with transferred hemorrhage into the brain or neuritis of the facial nerve.

Other interesting articles on this topic:

  1. Clinical study of the patient: eyes, pupils and nose
  2. Clinical study of the patient: state of consciousness
  3. Clinical study of the patient: family history
  4. Clinical study of the patient: skin
  5. Clinical study of the patient: language