Syndrome of "Crocodile Tears" Pharmacological study of a bilateral case

Pliny the Elder, whose writings are consistently more notable for their dramatic interest than for their scientific accuracy, related the story of the crocodile's hypocritical tears. After devouring the body of a victim, the reptile supposedly shed many tears over the head, before eating that also. Bogorad (I928) and Kaminsky (I929) applied the name "crocodile tears " to the syndrome of excessive lacrimation while eating. The more prosaic term for the syndrome, "paroxysmal lacrimation", is deservedly less popular. Although relatively uncommon, the crocodile tears syndrome is of considerable interest. Most cases are acquired and unilateral and usually follow a Bell's palsy affecting the same side. Normally, the facial nerve contains fibres which are secretomotor for the sub-mandibular salivary glands, as well as secretory fibres to the lacrimal gland. Anatomical features are discussed in detail by Savin (I939). The generally accepted explanation of the pathogenesis of crocodile tears (Walsh, 1957) is that, during recovery from Bell's palsy, regenerating salivary fibres in the facial nerve become misdirected and innervate the lacrimal gland. Stimuli such as the taste or smell of food, which normally would excite a flow of saliva, may then produce a simultaneous flow of tears on the same side as th