Peripheral facial palsy in the past: contributions from Avicenna, Nicolaus Friedreich and Charles Bell

Paralisia facial periférica nos velhos tempos: as contribuições de Avicenna, Nicolaus Friedreich e Charles Bell

HISTORICAL NOTES

Peripheral facial palsy in the past: contributions from Avicenna, Nicolaus Friedreich and Charles Bell

Paralisia facial periférica nos velhos tempos: as contribuições de Avicenna, Nicolaus Friedreich e Charles Bell

Luiz Antonio de Lima Resende^I; Silke Weber^II

^IDepartment of Neurology, Psychology and Psychiatry - Botucatu School of Medicine, UNESP, Botucatu SP, Brazil

^IIDepartment of Ophthalmology and Otolaryngology - Botucatu School of Medicine, UNESP, Botucatu SP, Brazil

ABSTRACT

This study provides historical documents of peripheral facial palsy from Egypt, Greece and Rome, through the middle ages, and the renaissance, and into the last four centuries. We believe that the history of peripheral facial palsy parallels history of the human race itself. Emphasis is made on contributions by Avicenna and Nicolaus Friedreich. Controversies about the original clinical description by Charles Bell are also discussed.

Key words: peripheral facial palsy, history.

RESUMO

Este estudo apresenta documentos de paralisia facial periférica nas artes plásticas no Egito antigo, Grécia e Roma, Idade Média, Renascimento e também dos últimos 4 séculos. Pensamos que a história da paralisia facial periférica acompanha a história da própria espécie humana. São apresentadas as contribuições de Avicenna e Nicolaus Friedreich, e são mostradas controvérsias sobre a descrição original de Charles Bell.

Palavras-chave: paralisia facial periférica, história.

Charles Bell wrote ..."the human being's facial expression fascinates me, because it serves the most basic and bestial pleasure and participates in the strongest and most gentle emotion of spirit"¹. With this he defined the philosophical importance of peripheral facial paralysis, which eliminates facial symmetry, one of the attributes of beauty, thus creating an antiesthetic effect that minimizes man's pleasure or increases his suffering. Peripheral facial paralysis has been represented in arts since ancient Egypt.

Our objective in this work is to present different artistic documents of this clinical condition throughout history.

METHOD

Issues of Index Medicus from 1950 to 2005 were consulted to collect and select scientific papers on the history of peripheral facial paralysis. The most relevant data mainly from artistic representations were selected, and presented in chronological order.

RESULTS

The results are presented in chronological order as: Ancient times (Fig 1); The Middle Ages (Fig 2); Pre-Columbian America (Fig 3), The Renaissance (Fig 4); Facial paralysis in different regions of the world (Fig 5 and 6); The last centuries (Fig 7).

DISCUSSION

As be seen, peripheral facial palsy was known to the Egyptians, Greeks, Romans, Incas and other native cultures in Pre-Columbian America. The Egyptian peripheral facial paralysis presented in the Figure 1A is probably one of the first documents in the history of neurology. Recent works have indicated that the "Mask of Agamemnon", a gold-face mask from approximately 1550-1500 B.C.¹⁰ and the face on a clay head mask found in Smyrne¹¹ probably show evidence of peripheral facial palsy. Figure 1B and 1C illustrate that peripheral facial paralysis was well documented in the Hellenistic period.

Roman doctor Aulus Cornelius Celsius, called "Cicero Medicorum", gave a summarized description of peripheral facial paralysis¹². Incas in pre-Columbian America have supplied us with several artistic representations of peripheral facial palsy⁵. Artistic representation of peripheral facial palsy has become more extensive since the Renaissance. Dutch painters portrayed people with peripheral facial paralysis during and after this period⁵. Old African masks could have be made for "moral education", to teach the young not to laugh at human deformity¹³.

The first medical study of the disease is attributed to Avicenna (Abu-Ali al Husayn ibn Abdalla Ibn Sina, 979-1037 A.D.). He was the first to record differences between central and peripheral facial paralysis: ... "If the disease that produces paralysis comes from the middle of the brain, half of the body is paralyzed. If the disease is not in the brain but in the nerve, only that depending on this nerve is paralyzed"⁴. Avicenna counted among the causes of peripheral facial paralysis, compression due to injury, tumor, or nerve sectioning. For treatment, he prescribed medicinal plants for topical application, all of them having a vasodilator effect. In some cases he recommended cauterization behind the ear in the region of the stylomastoid foramen, a procedure that also has a vasodilator effect. He also prescribed face and neck massage. He emphasized that "If sectioning of the nerve occurs, the only alternative is stump-to-stump suture"^4,8. As to prognosis, he stated that "no recovery should be expected from any facial paralysis that lasts more than six months"⁴. We can consider that Avicenna had very advanced knowledge on peripheral facial palsy for his time (979–1037 A.D.).

In 1798, Nicolaus A. Friedreich of Würzburg, grandfather of Nicolaus Friedreich of Heildelberg who described the ataxia as having been named after him, published a detailed study on the onset, clinical picture, evolution and treatment of peripheral facial paralysis in three patients¹⁴. Exposure to cold drafts had occurred in all three cases before paralysis onset. Thus Friedreich postulated that paralysis may occur when local causes act on the facial nerve¹⁴. He published his study in Germany in 1798 as ..."De paralysis musculorum faciei rheumatica". An English review of his paper was published in the journal Annals of Medicine in 1800 in Edinburgh, where Charles Bell was a medical student at the time. According to Bird (1979), it is possible that Charles Bell may have read this paper¹⁴. His first case of peripheral facial palsy was published in 1821, and his most important paper was published in 1828¹⁴. However Charles Bell made other contributions to the history of neurology and anatomy. He recognized the differences between the anterior and posterior division of the spinal nerves; he identified the thoracic long nerve; singled out the VIIth cranial nerve, separating it from Vth and VIIIth, described the Bell sign and was the first to described hyperacousis and dysgeusia as symptoms of peripheral facial paralysis after self observation and observations by Professor Roux from Paris^8,14. In conclusion, we think that the pioneers in the medical study of peripheral facial paralysis were: Avicenna, Nicolaus Friedreich and Charles Bell.

ACKNOWLEDGEMENTS – Figures in this work were kindly provided by Kugler & Ghedini, Kugler publications, P.O. box 20538, 1001 NM Amstelveen, The Netherlands and by George-Thieme Verlag, Suttgart, Germany.

Received 8 April 2008, received in final form 9 June 2008. Accepted 1 July 2008.

Dr. Luiz A.L. Resende – Department of Neurology / Psychology and Psychiatry / Botucatu School of Medicine - 18618-970 Botucatu SP - Brasil. E-mail: [e-mail]

• 1. Bell C. Essays on the anatomy of expression in painting, 1806. In: Jongkees LBW. Bemerkungen zur Geschichte der Fazialischirurgie. HNO 1979;27:326.
• 2. Kindler W. Die Fazialislähmungen in der darstellenden Kunst vor mehr als zwei Jahrtausenden. Z Laryngol Rhinol Otol 1969;48:135-139.
• 3. Kindler W. Die Fazialislähmungen in der darstellenden Kunst vor mehr als zwei Jahrtausenden. Z Laryngol Rhinol Otol 1961;40:413-425.
• 4. Kataye S. La paralysie faciale selon Avicenna. Ann Oto-Laryngol (Paris) 1975;92:79-82.
• 5. Goldman L, Schechter CG. Art in medicine. New York J Med 1967;67: 1331-1334.
• 6. Adour kk. Mona Lisa syndrome: solving the enigma of the Gioconda smile. Ann Otol Rhinol Laryngol 1989;98:196-199.
• 7. Walker M. Sir Charles Bell, his Palsy and Mona Lisa. Nepal J Neurosci 2004;1:123-125.
• 8. Jongkees LBW. Bemerkungen zur Geschichte der Fazialischirurgie. HNO 1979;27:325-333.
• 9. Kindler W. Die Fazialislähmungen in der darstellenden Kunst vor mehr als zwei Jahrtausenden. Z Laryngol Rhinol Otol 1970;49:1-5.
• 10. Appenzeller O, Amm M, Jones H. A brief exploration of neurological art history. J Hist Neurosci 2004;13:345-350.
• 11. Charlier P. Un nouveau cas de parlysie faciale sur une terre cuite smyrniote hellénistique. Hist Sci Med 2007;41:49-60.
• 12. Frieboes W. Aulus Cornelius Celsus über die Arzneiwissenschaft, 2^nd Ed. Brunswick: Friedrich Vieweg & Son, 1906:170.
• 13. Steiner CB, El-Mallakh RS. Depiction of facial paralysis on an African mask. Neurology 1988;38:822-823.
• 14. Bird TD. Nicolaus A. Friedreich´s description of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psychiatry 1979;42:56-58.

Publication Dates

• Publication in this collection
  15 Oct 2008
• Date of issue
  2008

History

• Accepted
  01 July 2008
• Reviewed
  09 June 2008
• Received
  08 Apr 2008