THE FACIAL. 545 



cheek, which, as well as the nostril, is flattened and collapsed. The 

 corner of the mouth hangs downward, and the lips cannot be kept in 

 contact with each other at this point, sometimes allowing the saliva to 

 escape by drops from the cavity of the mouth. 



Beside these symptoms there is also, in man, a deviation of the mouth 

 towards the sound side, owing to the facial muscles on that side being 

 no longer antagonized by those opposite. In many instances this de- 

 viation is not observable during a state of quiescence, since both sets 

 of muscles are then equally relaxed ; and it becomes evident only when 

 the patient begins to move the muscles of the sound side, as in speaking 

 or laughing, or when the emotions are excited. But in some cases, where 

 the face has naturally an abundance of expression, the distortion of the 

 features, and the consequent difference between the two sides of the 

 face, are distinctly shown even in the quiescent condition, and become 

 still more marked when the patient is excited or engages in conversa- 

 tion. 



Another secondary effect of facial paralysis in man is difficulty in 

 drinking and in mastication. The first is due to the impossibility of 

 contracting the orbicularis oris on the affected side ; so that the lips at 

 this corner of the mouth cannot be kept firmly in contact with the sides 

 of the goblet. The consequence is that a portion of the fluid escapes 

 and runs over the lower part of the face, unless the patient take the 

 precaution to aid the paralyzed part by pressure with his fingers. The 

 difficulty in mastication is not owing to any paralysis of the muscles 

 moving the lower jaw. These muscles are animated by the inferior 

 maxillary division of the fifth pair, and are unaffected in disease of the 

 facial nerve. It results from the paratysis of the buccinator muscle, 

 and the relaxed condition of the side of the cheek. In consequence of 

 this, the food in mastication lodges partially in the space between the 

 outside of the gum and the inside of the cheek; and the patient is often 

 obliged to remove it by mechanical means in order to complete its 

 mastication. 



The loss of power in the orbicularis oris also produces an imperfect 

 articulation. The lips cannot be brought together with sufficient pre- 

 cision, and consequently the labials, such as B and P, are imperfectly 

 pronounced. If the paralysis be bilateral, existing on both sides of the 

 face at a time, cases of which have been sometimes observed, the features 

 are no longer deviated from their symmetrical position, but the diffi- 

 culty of articulation becomes much increased, extending not only to 

 the labials proper, but also to such of the vowels, as and U, which 

 require a certain contraction of the orbicularis oris. This affection is 

 distinguished from that known as " glosso-labio-laryngeal paralysis." in 

 which articulation is also impaired. In the latter disease, which is of 

 central origin, the paralysis affects the muscles of the tongue and larynx 

 as well as those of the lips ; in facial paralysis it is confined to those 

 which receive their filaments from the facial nerve. Facial paralysis 

 ma} T therefore exist without danger to life. 



