352 DISEASES OF THE PERIPHERAL NERVES. 



Iii the beginning of the disease the affected side of the face is often 

 somewhat painful. Afterward the pain abates, and, as a great rarity 

 it is followed by incomplete anaesthesia. In some cases, instead of all 

 the nerve-fibres of the facial, a few only are involved in the morbid 

 irritability, as the palpebral branch, the malar, or the labial, or, as in a 

 case reported by Momberg, the auricular branch. The affection of the 

 rami palpebrales causes a series of rapid openings and shuttings of the 

 eye nictitatio, or a rigid, violent closure of the lids blepharospas- 

 mus. The derangement of the buccal and labial branches gives rise 

 to a movement of the lips, upon one or both sides, as if from laughter, 

 the so-called risus caninw, or sardonicus. In the case of tic convulsif 

 of the auricular branches, described by Romberg, repeated fits of 

 twitching of the ear set in daily, during which the ears were drawn 

 up and down for fifteen minutes at a time. Sometimes the tic con- 

 vulsif spreads to other nervous trunks, as does the tic douloureux ; so 

 that movement is excited in the muscles of mastication, or those in the 

 region of the hypoglossal nerve, and of the accessory of Willis, or of 

 some of the spinal nerves. 



The course of the disease is usually chronic, and of uncertain dura- 

 tion. Commencing suddenly (or gradually, which is rather more com- 

 mon), it generally continues during the remainder of life. In order 

 not to mistake the tonic form of mimic facial spasm for the distortion 

 of the face arising from hemiplegia, we must observe the unimpaired 

 muscular power of the undistorted side, and the normal behavior of 

 its muscles under the induced current. Moreover, according to Bruns, 

 in hemiplegic palsy, upon handling the healthy side of the face, we do 

 not find the smallest trace of permanent contraction of the muscles, 

 and, by stroking and drawing upon the skin of the face, the mouth 

 may be brought into proper position. 



TREATMENT. In recent cases of tic convulsif, a diaphoretic and de* 

 rivative procedure always seems to do good, while, according to my 

 experience, an old case resists all treatment, even the application of 

 electricity. Where the morbid irritation of the facial manifestly is of 

 reflex origin, and if we can tell from which filaments of the trigeminu? 

 the disturbance proceeds, division of those twigs from the brain by 

 neurotomy is indicated. In two cases reported by Romberg, where 

 the supra-orbital nerve was divided, great benefit was obtained. On 

 the other hand, division of branches of the facial nerve is not advisable, 

 as that procedure gives rise to another deformity scarcely less un- 

 pleasant than the former one, namely, mimic facial palsy. In one ob- 

 stinate case of tic convulsif, subcutaneous incision of the facial muscles 

 nas been practised by Dieffenbach, with good result. 



