Injuries of nerves and their consequences - Reflex Sympathetic ...

328 INJURIES OF NERVES.
rior wound is healed, but the posterior is open, and an
abscess, which formed below the left ear, is discharging
very freely. The parts in front of the ear are confused
in a mass of firm plastic deposit. There is total palsy of
the muscles of expression in the face. The brow and lid
hang, the cheek is flabby, the mouth pulled toward the
sound side. The tongue moves, but as the jaw
is locked
by the inflammatory deposit about the ramus, the cheek,
and the articulation of the maxilla, it cannot be closely
examined. He was long annoyed b}' the inability to
cover his eye with the lid ;
but has now learned to roll
the eye upward, so as to cover the iris. He then supposes
that he has closed the lid. Tliis same phenomenon
was noted by Sir C. Bell in several of his earlier cases.
The history of the present case is somewhat obscure,
nor can we be absolutely sure as to whether the portio
dura, which is paralj'zed, was primarily injured by the
ball, or secondarily aftected by the large and firm deposit
in front of the ear, which must of necessity have involved
all the facial branches of the nerve. The wound
nearly
was dressed with water without other treatment.
October 19, 1863.— The swelling has subsided one-half,
but there is still dead bone in the wound, probably a
piece of the ramus of the jaw. A mass of granulations
fills the outer ear, but the hearing does not seem to be
utter!}" lost. After tearing the granulations away,
it was
found that the membrane was gone, that there was some
inflammation of the middle ear, and that below the bony
meatus, and in front of it,
dead bone could be felt.
Faradisation of the face showed total loss of electric
contractility in all the muscles supplied by the portio
dura, and also in the posterior portion of the masseter,
which had been injured by the ball and by the subsequent
inflammation.
As the face was still inflamed in September, no attempt