The history of facial palsy and spasm: Hippocrates to Razi

Abstract

Although Sir Charles Bell was the first to provide the anatomic basis for the condition that bears his name, in recent years researchers have shown that other European physicians provided earlier clinical descriptions of peripheral cranial nerve 7 palsy. In this article, we describe the history of facial distortion by Greek, Roman, and Persian physicians, culminating in Razi's detailed description in al-Hawi. Razi distinguished facial muscle spasm from paralysis, distinguished central from peripheral lesions, gave the earliest description of loss of forehead wrinkling, and gave the earliest known description of bilateral facial palsy. In doing so, he accurately described the clinical hallmarks of a condition that we recognize as Bell palsy.

Figure. Facial palsy as described by Razi in al-Hawi

Razi provides an accurate description of facial palsy, differentiates central from peripheral causes (although not based on loss of forehead wrinkling), and provides potential complications for each. Modern equivalents of Razi's observations are shown in parentheses.