PALSIES 1. Facial Palsies A facial palsy is termed peripheral when the lesion affects the nerve at some point between the pons and the distribution of the nerve on the face; hence disease of the base of the brain may also procluce a peripheral facial palsy. There are eases of partial facial palsy in which only certain muscles of the face are involved. Facial palsy is not rare in childhood SinCe in aiddition to the "rheumatic form" which occurs spontaneously we also encounter congenital and otog,enic lesions of the facial nerve. "Congenital" facial palsy is generally caused by a birth injury, contusion or laeeration of the trunk of the nerve in the face by the pressure of the foreeps or some obstacle during the passage of the head through the pelvis. For genuine congenital faeial palsy, which may be bilateral :cliplegia faeialis , see the ehapter on "infantile nuclear atrophy.' A particularly frequent form of facial palsy is confined to the inferior branch of the nerve and leads to a permanent deformity in which the mouth is drawn over to one side. ;Spontaneous or so called rheumatic facial palsy is less frequent in the child than in the adult, The possibility of complete facial palsy, accompanied by fever and "exhibiting the signs of a peripheral or pontine paralysis," is mentioned by Oppenheim. The most frequent cause of facial palsy in a child is found in diseases of the ear, not so much simple purulent middle ear catarrh as a destruetive bone proeess (caries of the mastoid bone), which quite often rests on a tuberculous foundation. Diseases of the base of the brain (tumor, meningitis) rarely produce an uncomplicated facial palsy, other basal palsies and cerebral symptoms being usually associated. Finally we may occasionally see a faeial palsy, usually partial, after the removal of glands, tumors and the like in the face and at the angle of the jaws.
A pronounced peripheral facial palsy differs from the central form by the fact that it involves not only the two inferior, but also the frontal branch of the nerve. The diseased half of the face is flaccid, the naso
labial fold obliterated, the corner of the mouth drawn toward the sound side; the forehead is smooth on the paralyzed side and the eye cannot be completely closed (lagophthalnaus); when the child closes its eyes the globe is rotated under the upper lid. The inequality on the two sides of the face becomes very evident whenever the facial muscles are brought into play. Electric irritability is diminished or reaction of de generation in the form of sluggish, and sometimes inverse contractions are present, or the muscles fail to respond altogether to currents of bear able severity. The prognosis in regard to recovery is determined by the nature of the electric reactions (luring the first two weeks after the beginning of the palsy. Diminution in the secretion of saliva and the lachrymal secretion and loss of the sense of taste are not infrequently observed. The insufficient closure of the lid during sleep often leads to irritation of the con junctiva. Pain and parsthesia are rare in simple facial palsy, but we sometimes observe cedema and herpetie eruptions on the paralyzed side.
Facial palsy due to sofne birth anomaly almost always runs a favorable course. With few exceptions, the cases recover in a week or two. The rheumatic form also frequently ends in recovery. On the other hand, facial palsy due to aural diseases runs a less favorable course because the primary cause does not sub side so soon. Variations and remissions after apparent recovery are observed. But ultimately these eases also not infrequently end in recovery. Sometimes contractures develop in the muscles of the diseased side and make it difficult to decide which side is paralyzed. Since in cases of basal palsy and those due to diseases of the ear, the facial palsy is only a sytnptom of a more extensive disease the general health of such patients is impaired and they may succumb to the primary trouble.