Mona Lisa…..Smile!

Robert Traynor
April 8, 2015

mlIt is said that the Mona Lisa  is “the best known, the most visited, the most written about, the most sung about, the most parodied work of art in the world.” The painting, according to Total History (2015), is a half-length portrait of a woman by the Italian artist Leonardo da Vinci (1452-1519).   The subject is thought to be the portrait of Lisa Gherardini Giocondo (1479-ml21551), the wife of Francesco del Giocondo (1465-1538), a wealthy silk merchant in Florence who was involved in the high society of government with the Medici family. The painting was commissioned to commemorate the building of a new house and the birth of the Giocondos’ second son. 

Little is known of Lisa’s life beyond that she was born in Florence to a family of stature, married in her teens, was the mother of five children, and led a comfortable middle class life.  The painting is in oil on a white Lombardy Poplar panel, and is believed to have been painted between 1503 and 1506, although Leonardo may have continued working on it as late as 1517.   It is unusual in that most paintings of the time (and still) are commissioned as oil on canvas, but the use of the Poplar panel is part of what has attributed to the fame of the painting. Because of the medium used for the image, the Mona Lisa has survived for six centuries without ml1ever being restored, which is very rare for a painting from this period.  The Mona Lisa is also unusual because most artwork from the Renaissance period depicts biblical scenes, and the style and technique of most paintings of this period distinguish them from paintings from other eras.

Da Vinci, having studied anatomy intensively, created anatomically correct works of art during this period.  Experts describe the ambiguity of Lisa’s enigmatic expression as one of the continuing fascinations of the painting.  Additionally, the detail of her hands, eyes, and lips are enhanced by a shadowing technique, giving Mona Lisa an extremely lifelike appearance as well as look of amusement. Without the usual brushstrokes of the period, Da Vinci also created a background of aerial views and beautiful landscape muted from the vibrant lightness of the sml3ubject’s face and hands.  Her facial expression has been the subject of debate for centuries, as her mysterious expression has been difficult to interpret. 

Dentists have suggested that her smile was the result of her hiding teeth that were not presentable; others have speculated that she was melancholy or even a man in drag.  For Da Vinci, the “Mona Lisa” was forever a work in progress, as it was his attempt at perfection. The painting was never delivered to its commissioner; Leonardo kept it with him until the end of his life. While the painting has been on permanent display at the Louvre in Paris since 1797, there is actually more to the painting than just art: the Mona Lisa Syndrome

………….But What Does the Mona Lisa Syndrome Have to Do With Audiology?

Audiologists working in ENT clinics with physicians in the diagnosis of disorders encounter a number of patients with Bells Palsy.  Electroneuronography (ENoG) and acoustic reflex testing are a part of evaluating patients with facial nerve involvement.  If you look at that mysterious Mona Lisa smile, you will see that the left side of her mouth has a hint of facial nerve paralysis. According to Adour (1989) this would be the Mona Lisa Syndrome, known also asml4 Idiopathic facial nerve paralysis.

Idiopathic facial nerve paralysis was first

Sir Charles Bell

Sir Charles Bell

described by Sir Charles Bell (1774-1842) in the early 19th century, but Sir Charles notices that the syndrome bearing his name was two to four times more common in females than in males and that pregnant women were three to four times more affected than non-pregnant woman. 

Bell’s palsy is believed to be caused by inflammation of the facial nerve at the geniculate ganglion, which leads to compression and possible ischemia and demyelination. This ganglion lies in the facial canal at the junction of the labyrinthine and tympanic segments, where the nerve curves sharply toward the stylomastoid foramen.ml6 Classically, Bell’s palsy has been defined as idiopathic, and the cause of the inflammatory process in the facial nerve remains uncertain. Increased extracellular fluid, viral inflammation, and the relative immune suppression of pregnancy are thought to be predisposing factors. A unique feature of reported cases of Bell’s palsy in pregnancy is the presentation during the third trimester, or the immediate post-partum period.  Hellebrand et al. (2006) has suggested that Mona Lisa was pregnant shortly before the famous painting was made and that her famous asymmetrical smile is the result of facial muscle contracture and/or synthesis after Bell’s Palsy, when the facial nerve has undergone partial wallerian degeneration and then regenerated. As Adour (1989) put it, the smile is a classic example of Leonardo da Vinci as the compulsive anatomist who combined art and science.  Adour further stated that some nerves grow along aberrant pathways, resulting in synkinesis, leading to involuntary contraction of multiple facial muscles in the process of one or more Trvel Via Italy:  voluntary motions.  Today this condition is not treated very differently from idiopathic facial nerve palsy, but recovery and development of the aberrant pathways may require approaches like cosmetic surgical techniques or botulinum toxin (Botox) injections.


Totally History (2015).  Mona Lisa.  Retrieved April 7, 2015:
Hellebrand,M.,Friebe-Hoffman,U.,Bender H., Kojda,H., Hoffman T., Mona Lisa Syndrome, Iodopathic facial nerve paralysis during pregnancy.   Z Geburtshilfe Neonatol. 2006 Aug;210(4):126-34:  Retrieved April 7, 2015:
Adour, K., (1989). Mona Lisa syndrome: solving the enigma of the Gioconda smile.   Annals of Otology, Rhinology, and Laryngology, vol. 89, no. 3, March 1989, pp. 196-9 Retrieved pril 6, 2015: 
Letters of Note (2015:  Leonardo da Vinvci:  Retrieved April 7, 2015:
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