. A treatise on nervous and mental diseases, for students and practitioners of medicine. that are brought under treatment in the early stage, and badin almost all others. The diagnosis of a facial paralysis is a matter of no difficulty, asthe open eye, the flattened face, and the cheek bellying out when anymarked expiratory efforts are made, are pathognomonic. But it mustbe remembered that the causative lesion may be peripheral, in themiddle ear, at the base of the cerebrum, or in the nucleus of origin ofthe nerve in the medulla oblongata. The course of the facial in theinternal capsule (pp. 3
. A treatise on nervous and mental diseases, for students and practitioners of medicine. that are brought under treatment in the early stage, and badin almost all others. The diagnosis of a facial paralysis is a matter of no difficulty, asthe open eye, the flattened face, and the cheek bellying out when anymarked expiratory efforts are made, are pathognomonic. But it mustbe remembered that the causative lesion may be peripheral, in themiddle ear, at the base of the cerebrum, or in the nucleus of origin ofthe nerve in the medulla oblongata. The course of the facial in theinternal capsule (pp. 38 and 125), as well as the cortical centre (), need not be considered in this process of differentiation, becausea lesion of either site would not involve the fibres to the eyelid on oneside, and the levator palpehroe superioris would not be paralyzed. Aperipheral site of the lesion may be diagnosed by exclusion of one inthe middle ear, the cerebrum, or the medulla. Fig. 107 will show therelation of the facial nerve to the middle ear. Fig. 108 gives an Fig. 108. Chorda Tyrr^ani,. View of the inner wall of tympanum, enlarged. (Gray.) excellent view of the inner wall of the tympanum. From these twofigures a clear idea can be obtained of the branches of the facial nerveand its connection with the middle ear. A lesion in the aqueduct ofFallopius, situated between 3 (Fig. 107), the stapedius nerve fila-ment, and 2, the chorda tympani, will cause impairment of the senseof taste in the corresponding anterior two-thirds of the tongue, aswell as diminished salivary secretion on tlie same side. If there is alesion between the nerve filament to the stapedius (3, Fig. 107) andthe geniculate ganglion (1), there will also be abnormal acuteness ofhearing—hyperacusis. Implication of the geniculate ganglion itself 190 NERVOUS DISEASES. adds paralysis of the soft palate and distortion of the uvula to thevSymptoras. A lesion above the geniculate ganglion will cause mostof these symptoms—
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