FACE, DISEASES OF. -.\ number of affections may he localised in the facial region. These may involve the sensory nerves, giving rise to pain, facial neuralgias, etc., chief of winch are those due to defective teeth ; or they may involve the facial motor nerves, causing facial spasms (tics), or facial paralysis (Bell's Palsy), or wasting of the muscles of the face. The nerves chiefly involved are the fifth, causing sensory symptoms, and the seventh, affections of which cause the motor symptoms, the paralyses. The spasms, or tics, are probably of cerebral origin.
Atrophy of the Face.—.\ rare affection which is characterised by a wasting of one side of the face. It is due to a severe injury to the nerve, and manifests itself by a slow and gradual wasting, first of the skin, then of the fatty tissue, and finally of the bone. This causes the affected half of the face to fall in (see Plate XVIII., 4). The disease occurs most frequently during youth and in the female sex. A retrogression of the symptoms is very rare. Apart from a slight inconvenience in chewing, there is little to disturb the patient's health. The progress of the disease ceases, as a rule, when it has reached a certain development, and thus the distortion of the face does not go on indefinitely. The lesion is usually in the medullary centres.
Pains of the Face.—These occur frequently in the region of the trigeminal nerve as the result of injuries, exposure to cold, or bodily disease (such as typhoid, influenza, or gout). Affections of the nose, ear, and particularly of the teeth may also be factors. The nerve-branches most frequently affected are the superior and inferior orbital nerves—causing headaches in the regions of the forehead and eye, and those nerves which supply the region of the lower jaw—causing toothache. The most severe form, which is especially designated as " tic-donloureux," is the excruciating, twitching pain which appears in lightning-like flashes in two or three places, mostly confined to one half of the head. At the onset of this latter
affection it is possible to effect a cure by systematic stretching of the skin and muscles, and by other methods to be determined upon by the physician. Severe and chronic cases must he treated by surgical measures, injections of osmic acid, nerve cutting, or by destruction or removal of the Gasserian ganglion.
Patients suffering from facial pains should consult their physician as to the treatment, and should beware of the numerous, greatly extolled " head ache " and " pain-killing " remedies, such as antipyrine, acetanilide, phena cetine, orangeine, migrainine, etc. ; and they should especially avoid the use of opium in any form.
Paralysis of the Face. This condition is brought about by injury to the seventh, or facial nerve, which controls the movement of various facial muscles, such as those of the forehead, eyelids, cheeks, lips, and chin. If the nerve be disordered or destroyed, the result Nvill be partial or complete paralysis of that half of the face which is supplied by the affected nerve. As a rule, the affection is not painful. In case of a complete paralysis of one side of the face, the patient presents the following appearance (see Plate XVIII., 2) : One side of the face appears distorted, and, strange to say, the abnormality seems to the non-medical mind to be situated in the healthy side of the face and not in the affected part. When speaking, the patient moves only the healthy half of the face, the paralysed side remaining flaccid, rigid, or quiet. The normal facial wrinkles and folds show on the unaffected part of the face, but have disappeared on the diseased part. The corner of the mouth droops, and owing to the paralysis of the muscles of the lips and cheek the patient is unable to pucker his lips, to whistle, and to knit his brows. It often happens that he is unable to close the eye of the affected side, and that he bites the mucous membrane of the cheek when he eats.