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Do Lack Of Forehead Movement And Soft Tissue Swelling Post Head Injury Need Medical Attention?
Question: I had a fall and clocked my head (left eyebrow point area) on cement last Sunday ( 1 week ago). CT negative for subdural etc....8 stitches to my temple now out. I am noticing that I have no movement of my left forehead does not move at all. I have soft tissue sweeping and I can feel a hematoma at my eyebrow point. And there is a black eye. I called my hospital and they told that they could not speak to me because I have Aetna insurance. They transferred me to Aetnan Nurse line and they did there assessment and come up with me going to the ED. I am a Nurse and do not feel that this is a medical emergency...not dizzy, LOC or internal Headcache...just local bone pain. My corneal reflex is intact and I have sensation on eyelid and forehead. Do you think that the lack of forehead movement is secondary to soft tissue swelling. Or can one stun the upper trigeminal branch with these types of traumas?
Brief Answer:
Doesn't look like a medical emergency.
Detailed Answer:
I read your question carefully and I understand your concern.
Judging from the description you provide I do not think that it is a medical emergency either.
First must precise that movement of facial muscles including forehead is done by facial nerve, the trigeminal nerve is responsible for sensation (which you say to be intact). I do not think this is a case of facial nerve involvement either because it would affect the lower part of the face.
There are two types of facial paresis central one due to brain involvement and peripheral due to damage to peripheral nerve itself. Clinically the difference is that the central one usually involves the lower two thirds of the face sparing the forehead (so the contrary of what you describe) while the peripheral one involves the whole half of the face. So in both scenarios lower part should be included.
For that reason I suggest you check again for movement in the lower part of the face, doing in front of the mirror actions like smiling and showing your teeth, puffing your cheeks etc in order to check for weakness in the lower part of your face. Only if there is weakness or asymmetry there can a facial palsy be suspected and should check in ED.
Otherwise if there is no such weakness, no other symptoms such as vision abnormalities, double vision, weakness of the limbs on one side, confusion or abnormal behavior noted by others I would say there is no indication of a traumatic brain damage which would constitute an emergency, probably issue is due to soft tissue damage and will subside with time.
I hope to have been of help.
Doesn't look like a medical emergency.
Detailed Answer:
I read your question carefully and I understand your concern.
Judging from the description you provide I do not think that it is a medical emergency either.
First must precise that movement of facial muscles including forehead is done by facial nerve, the trigeminal nerve is responsible for sensation (which you say to be intact). I do not think this is a case of facial nerve involvement either because it would affect the lower part of the face.
There are two types of facial paresis central one due to brain involvement and peripheral due to damage to peripheral nerve itself. Clinically the difference is that the central one usually involves the lower two thirds of the face sparing the forehead (so the contrary of what you describe) while the peripheral one involves the whole half of the face. So in both scenarios lower part should be included.
For that reason I suggest you check again for movement in the lower part of the face, doing in front of the mirror actions like smiling and showing your teeth, puffing your cheeks etc in order to check for weakness in the lower part of your face. Only if there is weakness or asymmetry there can a facial palsy be suspected and should check in ED.
Otherwise if there is no such weakness, no other symptoms such as vision abnormalities, double vision, weakness of the limbs on one side, confusion or abnormal behavior noted by others I would say there is no indication of a traumatic brain damage which would constitute an emergency, probably issue is due to soft tissue damage and will subside with time.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. This seems to be my general sense of things. I do appreciate the teaching that you have given me separating out sensory from movement inervations. It is reassuring and good news. Yes, my lower face works perfectly well. I guess when the fluid resorbs from all of the swelling my wrinkles and movement will return then. Thank you for your consideration of my concern.
Brief Answer:
You're welcome
Detailed Answer:
I hope you will be back to normal very soon.
You're welcome
Detailed Answer:
I hope you will be back to normal very soon.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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