Corneomandibular reflex

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC108345

Seven patients are presented in whom a prominent corneomandibular reflex was observed. These patients all had severe cerebral and/or brain-stem disease with altered states of consciousness. Two additional patients with less prominent and inconsistent corneomandibular reflexes were seen; one had bulbar amyotrophic lateral sclerosis and one had no evidence of brain disease. The corneomandibular reflex, when found to be prominent, reflects an exaggeration of the normal. Therefore one may consider the corneomandibular hyper-reflexia as possibly due to disease of the corticobulbar system.

http://archopht.jamanetwork.com/article.aspx?articleid=627241

The corneomandibular reflex, or von Sölder phenomenon, is an automatic, involuntary movement of the mandible elicited by touching the cornea. This phenomenon is helpful in diagnosis of supranculear lesions of the trigeminal nerve. It simply requires observation of the relaxed and slightly opened jaw when the cornea is stroked with a cotton wisp, and it can be handily included in the testing of corneal sensation. A prominent deviation of the jaw, the result of homolateral contraction of the external pterygoid muscle, constitutes a positive response.

http://archneur.jamanetwork.com/article.aspx?articleid=1674016

Corneomandibular Reflex (Wartenberg Reflex) in Coma - A Rarely Elicited Sign

 A 52-year-old man underwent emergent surgery for a dissecting aneurysm of aorta type A (dissection of ascending, arch, and descending thoracic aorta) and remained intubated. Neurological examination revealed dilatation of the left pupil (6 mm) with no light response. Oculocephalic and oculovestibular reflexes were abolished. There was bilateral Babinski sign and bilateral decerebrate posture after pain stimuli. Stimulation for testing the corneal reflex elicited a normal direct response, an absent consensual response, and a horizontal movement of the mandible to the contralateral side (corneomandibular reflex [Wartenberg reflex]) ( ) on both sides. Neuroimaging showed a massive cerebral infarct. The patient died 7 days after the initial neurological consultation.

Corneomandibular reflex consists of contralateral deviation of the mandible. It is suggested that a supranuclear lesion of the trigeminal nerve provokes an associated movement between the orbicularis oculi and the external pterygoid muscles.

The reflex may be present in acute coma (especially if due to a structural lesion), cerebrovascular disease, multiple sclerosis, Parkinson disease, and amyotrophic lateral sclerosis. In acute unilateral supratentorial lesions such as infarcts or hemorrhages, the reflex is elicited contralaterally. In most cases with bilateral corneomandibular reflex, there have been bilateral brainstem pathological findings or a unilateral hemispheric lesion with secondary pressure on the brainstem.