TEMPOROMANDIBULAR JOINT

Chvostek Test
 
A. Brief APK
Chvostek sign is a contraction of facial muscles provoked by lightly tapping over the facial nerve
anterior to the ear as it crosses the zygomatic arch. This induces twitching of the homolateral
facial muscles due to hyperexcitability of the nerve. Chvostek sign is observed in hypocalcaemic
states, such as hypoparathyroidism and the respiratory alkalosis associated with hyperventilation.

The pathophysiology of this mechanosensitivity of nerve fibres is uncertain, but is probably

related to increased discharges in central pathways. Although hypocalcaemia might be expected
to impair neuromuscular junction transmission and excitation-contraction coupling (since Ca 2+
ions are required for these processes) this does not in fact occur. This test is used to determine
whether there is pathology involving the seventh cranial (facial) nerve.

B. Starting position
Patient is in an upright sitting position with his head
in a neutral position.
 
C. Procedure

1. Using the index finger, the therapist taps the

parotid gland underlying the masseter muscle
approximately the facial nerve about 2 cm anterior
to the external auditory meatus. 

2. Take note of the facial muscle response.

 

D. Results and interpretation (Positive)

If the ipsilateral facial muscles twitch, the test is
considered positive.
 
E. Results and interpretation (Negative)
If the ipsilateral facial muscles have no response, the test is considered negative.
 
F. Current Clinical Relevance
Test has insufficient statistical (research) evidence, but it may demonstrate clinical support for its
use in the hands of an experienced examiner along with the history and examination making a
clinical diagnosis.