Bell's Palsy and Its Semantic Change over Time.

BACKGROUND: From 1821 to 1829, Sir Charles Bell presented cases of facial paralysis from infection, trauma, and unknown causes. As such, "Bell's palsy" initially referred to facial palsy of any etiology. Today, the term is reserved for idiopathic peripheral facial palsy. The objectives of this analysis were to establish when the eponym came to vogue and delineate the semantic shift from its original definition to its current one. METHODS: Extensive review of available 19th and 20th century literature mentioning "Bell's palsy" and "Bell's paralysis." RESULTS: Historical accounts have eponymously attached Bell's name to facial paralysis as early as the 1840s-Bell's palsy was first used to describe cases of facial palsy of any cause. In 1886, Gowers characterized Bell's palsy as a "neuritis usually within the Fallopian Canal," distinguishing it as a separate etiology. Over the next decades, the definition narrowed to peripheral facial paralysis from cold exposure or unknown causes. By the 1940s, its natural history was well described-an acute, unilateral, idiopathic, and usually self-limited peripheral facial palsy. CONCLUSION: The semantic change of a word over time can tell us a remarkable story of its history and origins. Absence of a discrete lesion, lack of proven treatment, and good prognosis without intervention distinguished Bell's palsy from other causes of facial paralysis. Over time, the definition has narrowed from a facial palsy of any cause to an idiopathic peripheral facial palsy. Recent evidence supporting Bell's palsy as a viral mononeuritis may have driven its recent semantic change toward this specific etiology.

ART IN MEDICINE: A RETROSPECTIVE ON THE ANATOMICAL DRAWINGS OF CHARLES BELL.

Perhaps best known for his discovery of the eponymous syndrome 'Bell's Palsy', Charles Bell (1774-1842) made significant contributions to neuroscience, medical education and philosophy. Our aim was to examine his neuroanatomical drawings in the context of the era in which they were produced and their influence on future scholars. Emphasis is placed on analysing the artistic techniques employed and Bell's unique manner of conveying both structure and function. The images discussed include those featured in his book entitled The Anatomy of the Brain: Explained in a Series of Engravings. These images can be viewed in parallel with his writing on the anatomy of the brain, in which he describes the usual manner of demonstrating neuroanatomy as 'dull' and 'unmeaning'. His mastery of artistic technique complements his insightful descriptions of this prodigiously complex organ. The result is a more engaging account of neuroanatomy and an impressive display of his skill as an artist, anatomist and physician. Examining these expressive portrait-like diagrams provides greater insight into the mind of the pioneer of modern neuroscience.

The Disputed Discovery of Facial and Trigeminal Nerve Function: Revisiting the Contributions of Herbert Mayo and Charles Bell.

BACKGROUND: The first description of the voluntary motor function of the facial nerve and separate sensory-motor contributions of the trigeminal nerve is most commonly attributed to Charles Bell. However, a review of the original scientific accounts and subsequent historical publications question the validity of this credit. The objective of the present historical analysis is to clarify the contributions of Herbert Mayo toward discovering the functions of the fifth and seventh cranial nerves and to raise awareness of this historical controversy within the medical literature. METHODS: Review of Charles Bell's and Herbert Mayo's original dissertations published between 1821 and 1823, and subsequent reports relevant to these primary works. RESULTS: Bell's submissions to the Royal Society of London in 1821 and 1822 describe the seventh nerve as the "respiratory nerve of the face" responsible for involuntary coordination of facial movement with the organs of respiration. Separately, Bell states that the fifth nerve is responsible for sensibility and voluntary movement of the facial muscles. In these accounts, Bell only peripherally alludes to the motor function of the seventh nerve and often comments inaccurately on fifth and seventh cranial nerve innervation. In contrast, in 1822 and 1823, Herbert Mayo first accurately and unequivocally defined the voluntary motor function of the facial nerve and sensory-motor function of the trigeminal nerve on the basis of his detailed experiments. The ultimate transfer of acknowledgment to Bell was rooted in surreptitious reworking of Bell's original dissertations and personal attacks against Mayo rather than arguments of scientific merit. CONCLUSION: Several notable clinicians and anatomists have contributed to our current understanding of the anatomy and physiology of the facial and trigeminal nerves, including Charles Bell; however, Herbert Mayo should be remembered for first providing a more accurate and clear description of their separate functions.

Bell's palsy: aetiology, clinical features and multidisciplinary care.

Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus-axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy.

[Bell and his palsy]. / Bell en zijn verlamming.

Unlike his eponymous fame suggests, Sir Charles Bell (1774-1842) was an anatomist, draughtsman and surgeon rather than purely a physiologist. He was born and educated in Edinburgh but spent most of his working life in London (1804 to 1836). It was there he started a School of Anatomy, alongside a fledgling surgical practice, just as his elder brother John had done in Edinburgh. In 1814 he joined the surgical staff at the Middlesex Hospital. In 1810 he surmised from occasional animal experiments that the anterior and posterior spinal roots differed in function. Yet it was left to the Frenchman Magendie to identify that these functions were motor and sensory: a discovery that induced Bell into an ungentlemanly feud. Bell also slightly erred on the functions of the trigeminal and facial nerve, but his description of the features of idiopathic facial palsy is unrivalled.

Esmail Jorjani (1042-1137) and his descriptions of trigeminal neuralgia, hemifacial spasm, and bell's palsy.

Esmail Jorjani was a prominent Persian physician of the 11th and 12th centuries. We present Jorjani's descriptions of probable trigeminal neuralgia, hemifacial spasm, and Bell's palsy. Additionally, on the basis of our translations of his original text, we believe that Jorjani may have been the first to implicate an artery-nerve conflict as an etiology of trigeminal neuralgia. This theory, documented in Jorjani's Treasure of the Khawarazm Shah and elaborated on by Dandy and Jannetta, constitutes the basis of a modern surgical approach to trigeminal neuralgia. The authors also describe the life and works of Esmail Jorjani and review his Treasure for its descriptions related to the aforementioned cranial nerve pathologies.

Bell's palsy before Bell: Evert Jan Thomassen à Thuessink and idiopathic peripheral facial paralysis.

Bell's palsy is the eponym for idiopathic peripheral facial paralysis. It is named after Sir Charles Bell (1774-1842), who, in the first half of the nineteenth century, discovered the function of the facial nerve and attracted the attention of the medical world to facial paralysis. Our knowledge of this condition before Bell's landmark publications is very limited and is based on just a few documents. In 1804 and 1805, Evert Jan Thomassen à Thuessink (1762-1832) published what appears to be the first known extensive study on idiopathic peripheral facial paralysis. His description of this condition was quite accurate. He located several other early descriptions and concluded from this literature that, previously, the condition had usually been confused with other afflictions (such as 'spasmus cynicus', central facial paralysis and trigeminal neuralgia). According to Thomassen à Thuessink, idiopathic peripheral facial paralysis and trigeminal neuralgia were related, being different expressions of the same condition. Thomassen à Thuessink believed that idiopathic peripheral facial paralysis was caused by 'rheumatism' or exposure to cold. Many aetiological theories have since been proposed. Despite this, the cold hypothesis persists even today.

Marathon of eponyms: 2 Bell palsy (idiopathic facial palsy).

The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185-186). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognised relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarises data about Bell paralysis.

Bell's palsy before Bell: Cornelis Stalpart van der Wiel's observation of Bell's palsy in 1683.

Bell's palsy is named after Sir Charles Bell (1774-1842), who has long been considered to be the first to describe idiopathic facial paralysis in the early 19th century. However, it was discovered that Nicolaus Anton Friedreich (1761-1836) and James Douglas (1675-1742) preceded him in the 18th century. Recently, an even earlier account of Bell's palsy was found, as observed by Cornelis Stalpart van der Wiel (1620-1702) from The Hague, The Netherlands in 1683. Because our current knowledge of the history of Bell's palsy before Bell is limited to a few documents, it is interesting to discuss Stalpart van der Wiel's description and determine its additional value for the history of Bell's palsy. It is concluded that Cornelis Stalpart van der Wiel was the first to record Bell's palsy in 1683. His manuscript provides clues for future historical research.

The surgical management of Bell's palsy: a review.

Facial nerve paralysis is a devastating problem for those affected. Few areas in otolaryngology have been as controversial as the management of Bell's palsy. The past several decades have witnessed many theories about the etiology and pathogenesis of Bell's palsy. In concert with each of these theories has been an appropriate management scheme. Because of the nature of the literature, it has been difficult for clinicians to unequivocally outline management algorithms. In the forefront of this debate is the issue of surgical therapy for a subset of these patients. Recent technology has provided some concrete insights into the mechanisms underlying Bell's palsy. Further, new clinical studies, albeit retrospective, support the need to re-evaluate surgery in the treatment of selected patients. The literature regarding the pathophysiology of Bell's palsy and the history of facial nerve surgery for this disease are reviewed.