Periscope of Medical and General Science in their Relations to Dentistry. [Volume: 2, Issue: 6, January, 1861, pp. 345-355]

350

THE DENTAL COSMOS.

the hanging of thie cheek is due to paralysis of the buccal nerve (of the
fifth) and the buccinator muscle.' The following case was one in which
the affection was evidently due to disease of the nerve in the aqueductus
Fallopii.
"A boy, aged five, was admitted a patient, under the care of Mr. Lawrence, in St. Bartholomew's Hospital, for discharge from both ears, attended with deafness and complete paralysis of the muscles supplied by
the facial division of the seventh nerve on both sides. As the boy was
quite deaf, it was impossible to get any clear history from him, and very
few opportunities occurred to obtain it from his friends. It was ascertained, however, that he had been in the Fever Hospital for eight
months (?), and that the paralysis had followed some exanthem for
which he had been in that hospital. He seemed in pretty good health,
and walked about the wards, though lame from some distortion of the
left tibia. He was fortunately a very intelligent child, and, though
he could not hear, he would endeavor to imitate motions made to him.
Thus, when the nurse, after obtaining his attention by motion, closed her
eyes, he attempted to do the same. The only result following his effort
to do so, however, was, that the upper lid fell a little, and the cornea was
carried upward under it so as to be quite covered. Although the lid
fell slightly, there did not appear to be the least action of the orbicularis: no winking. The gentleman to whose kindness we are indebted
for the notes of this case, states: 'I saw him asleep to-day, and his
eyes were not closed, but half open, and looking straight forward as if
he were awake.' This is interesting as regards the question of the position of the eyes during sleep. Sir Charles Bell held that in sleep the
eyeball was directed upward; but, as Dr. Todd states, it is so probably
only during strong contraction of the orbicularis, or, as in the case here
related, during an effort at contraction. He cannot frown or move his
mouth in the least, nor imitate any of the motions made by the muscles
of the face. When he tries to draw his mouth to one side he moves the
lower jaw altogether, and thus produces the effect by the muscles of mastication. He speaks very imperfectly, as his lips cannot assist in articulating labials. He can move his head well, and there does not appear to
be any paralytic affection elsewhere. In Dr. Todd's work, already alluded
to, is a very interesting case, reported by Mr. Holthouse, of double paralysis of this nerve, in which the symptoms produced are described in
detal. This patient was a man aged forty-two. He also was deaf, and
the disease apparently proceeded from an affection of the nerve, in its
course through the temporal bone.
"The following quotation from Romberg ('Diseases of the Nervous
System,' Sydenham Society's Translation) gives a good account of what
may be called the effect on the physiognomy of this form of double
paralysis: 'The effect is different when both facial nerves are paralyzed.
In two cases that have recently come to my notice, the face presented no
disfigurement beyond the eyes being distended; in one of the patients,
however, a man aged forty-three, the smoothness of the forehead and the
absence of every kind of furrow was remarkable. The absence of expression in speaking was yet more conspicuous in the beautiful countenance of a young lady. One of the patients was very sensitive on this
point, and termed it his greatest misfortune that he was forced to be joyful or sad without making any demonstration of his feelings to his fellowcreatures. In a girl of sixteen, in Dupuytren's 'Clinique,' who was