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This may be set up by disease of part of the cortex of the brain, of the facial nerve centres or of the nerve trunk itself in its later course. When it is due to disease of the cortex or of the facial nervous fibres radisting therefrom and gathered in the internal capsule, in all probability paralysis of the arm and leg (hemiplegia) on the same side will be present as well.
Only occasionally is the facial nerve centre itself attacked by disease, though it may be by tumours or haemorrhage. Here the symptoms found are the same as when the nerve trunk itself is involved. In this last named, if the paralysis results from disease in the lower part of the pons, crossed paralysis results, that is, paralysis of the face on one side and of the arm and leg on the other.
As the nerve arises from the brain it may be injured by fracture or pressed upon by tumours or inflammatory thickening. When within the internal ear, disease of that organ not infrequently brings about paralysis. Various injuries may have a similar result at its emergence from the skull, while a common cause of facial paralysis is inflammation of the nerve through cold, as in Bell's palsy (q.v.).
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Where the origin is central the outlook will naturally depend upon the type of disease, and the treatment will necessarily vary accordingly. When the condition follows ear disease, surgical measures may be required.
BELL'S PALSY: A FORM OF FACIAL PARALYSIS Injury or disease of the facial nerve induces a mask-like appearance on the affected side of the face, as there is inability to close the eye or to smile. The nerve may be affected while passing through the parotid glands or while it is still within the skull as, for example, in middle ear disease.
Bell's palsy is a paralysis or weakness affecting one side of the face, generally following exposure to severe cold. It is named after Sir Charles Bell, who first elucidated its nature in 1838. The part primarily involved is the facial nerve, which is specially liable to be disabled by the pressure of the slightest inflammatory effusion, because it issues from the brain through a loug and narrow bony canal near the ear.
Sitting by an open window, whether of a room or a railway carriage, sleeping with the face exposed to a draught of cold air, even the general prolonged exposure of the body to cold, are all exciting causes of Bell's palsy. Motoring in an open car is responsible for some cases. Occasionally the chill is so slight that its occurrence has been forgotten. People of rheumatic or gouty tendency are specially liable to attack.
The onset of Bell's palsy is marked by slight twitching of one side of the face. This occurs within twenty-four hours of the exposure to cold. The next day some distortion appears, the face being drawn to one side when smiling or frowning. Within two or three days the palsy is fully developed, constituting a striliing appearance which canuot fail to be recognized. No pain is felt.
Power of voluntary movement is lost over the entire side of the face. The mouth is drawn over towards the unaffected side owing to the pull of its healthy muscles. When opened wide it is markedly distorted. The eye cannot be closed nor the eyebrow raised. The cross wrinkles of the forehead cease abruptly at the middle line. There are no longer any creases around the eye or any dimples in the chin. While the face is in repose the condition may not be very obvious, but any emotional expression accentuates the deformity.
The muscles which move the jaws in mastication are not supplied by the facial nerve and therefore remain unaffected, yet Bell's palsy causes considerable disturbance in eating, because saliva and food accumulate within the flabby cheek and the tongue becomes furred on the affected side. Owing to one half of the lips being out of control, there is some defect of speech. After a time the conjunctiva of the eye may become inflamed, as blinking is impossible. The hearing in the affected ear map be more acute than normal.
In some cases the sense of taste is lost over the front part of the tongue on the paralysed side.
The condition described above persists for some twelve days. Favourable cases then begin to improve, and in about a month recovery is complete. A considerable number of cases, however, are of more serious type, and besides running a longer course these suffer from traces which continue throughout life. These after-effects consist of twitching and slight asymmetry They are due to a nervous over-action which follows prolonged paralysis. In any individual case, examination of the face muscles by electricity renders possible an estimate of the period of disablement. If the muscles react normally to the electric currcnt, recovery should take place within a month. Somewhat more severe cases may take two or three months. Cases showing what is called the reaction of degeneration (explained under Nervous Disease) will run a course lasting twelve to eighteen months.
In the early stages, hot boric fomentations frequently renewed should be applied to the ear and to the adjoining part of the cheek. After the first few days there are three objects to be attained. First the weakened muscles must be prevented from becoming stretched. This is achieved by pushing the face into shape frequently and by rubbing the eyelids over the eyeball. A compress or other protection should be worn over the eye at night. In the second place it is necessary to secure good blood circulation in the affected part. Massage and hot douches will accomplish this. Thirdly, the tone of the muscles is maintained by electro-galvanic stimulation used once daily, each muscle being caused to contract six times.