Value of face to determine the disease (part 2)
10. Thyrotoxic facies (Grave’s disease) Alert, startled, flushed and anxious appearance. Protrusion of of one or both eyes (exopthamlos) associated with retraction of the upper eyelids (lid lag) which results in the exposure of white conjunctiva above the cornea (Von-Graef’s sign). 11. Hatchet facies (Myotonia atrophica) They have a tented, open mouth, elongated face and blunt affect. This appearance often results from the re-shaping of facial bones in childhood and adolescence due to the progressive pulling and wasting of affected muscles. 12. Flat facies (Down syndrome) Flat appearing face, small head, flat bridge of the nose, smaller than normal, low-set nose, small mouth which causes the tongue to stick out and to appear overly large, upward slanting eyes, epicanthal fold, rounded cheeks, small misshapen ears. 13. Snarling or Myasthenic facies (Myasthenia gravis) Drooping of the eyelids and corners of the mouth and weakness of the facial muscles. 14. Mitral facies (Mitral stenosis) Rosy, flushed cheeks and dilated capillaries. 15. Elfin facies (William’s Syndrome) Sunken nasal bridge, puffiness around eyes, epicanthal fold, blue starry eyes, long upper lip length, small and widely spaced teeth, small chin. 16. Bovine facies (Craniofacial Dysostosis or Crouzon syndrome) Convex nasal profile, shortened mandible, macroglossia. 17. Bell’s palsy (Facial nerve dysfunction) The eyelids on the paralyzed side can’t close. The mouth is drawn to the unparalyzed side, producing a somewhat grotesque appearance. Food and drink dribble from the mouth on the paralyzed side. The eye with the involved lid dries due to decreased tear production. 18. Amiodarone facies Deep blue discoloration around malar area and nose.