PROF.ZHANG ANLI'S EXPERIENCE OF TREATING STUBBORN CASES OF FACIAL PALSY

Based on her own experience of many years＇ clinical practice, Prof. Zhang Anli summarized and created the method in which the shallow insertion at the upper eyelid, acupuncture at the Back-shu points and balanced selection of points together with the modified Setting Mountain on Fire and application of Fire Needle were applied for the treatment of stubborn cases of facial palsy. The therapeutic effect is good.

COMPARATIVE STUDY ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE AND WESTERN MEDICINES FOR TREATMENT OF PERIPHERAL FACIAL PALSY

Subjective: To observe the therapeutic effect of acupuncture in treatment of acute peripheral facial paralysis. Methods: A total of 80 cases of facial palsy were randomly divided into acupuncture group (n=50) and Western medicine (control) group (n=30). In acupuncture group, Cuanzhu (BL 2), Sibai (ST 2), Yangbai (GB 14), etc. were punctured, combined with TDP radiation, cupping or administration of Chinese medicinal herbs according to the concrete situations. Acupuncture treatment was given once daily, with 6 days being a therapeutic course, continuously for 4 courses. In control group, patients were treated with intravenous injection of “energy mixture”, dexamethasone, compound Danshen injectio, etc.. Results: After treatment, in acupuncture group, of the 50 cases, 48 were cured and 2 had improvement, with the effective rate being 100%; among them, 12 cases were cured in 7 days, 23 cured in 8～14 days, 10 cured in 15～21 days and 3 cured in 22～28 days. In control group, of the 30 cases, 19 were cured, 8 had improvement and 3 had no apparent changes, with the effective rate being 90%. Of the 19 cured cases, 5 were cured within 8～14 days, 10 cured in 15～21 days and 4 cured in 22～28 days. Conclusion: In treatment of acute periphery facial palsy, acupuncture is obviously superior to Western medicines in the therapeutic effect and cure duration.

TREATMENT OF 150 CASES OF FACIAL PALSY WITH ACUPUNCTURE PLUS TDP IRRIDIATION

In the present paper, the author summarizes the results of treatment of 150 cases of facial palsy with acupuncture plus TDP irradiation. Main acupoints used are Baihui (GV 20), Yintang (EX HN 3), Sibai (ST 2), Dicang (ST 4) and Hegu (LI 4). After insertion, the needles are retained but not manipulated, and the acupoints are irradiated with TDP for 20-60 min every time. The treatment is conducted once daily, with 10 sessions being a therapeutic course. Following 6-28 sessions of treatment, of the 150 cases, 145 are cured, 2 experience remarkable improvement and 3 have improvement, with the total effective rate being 100%. The fact indicates that acupuncture plus TDP irradiation is rather effective in the treatment of facial palsy.

EFFECT OF NEEDLING STIMULATION QUANTITY ON THE THERAPEUTIC EFFECT OF ACU-MOXIBUSTION IN THE TREATMENT OF PERIPHERAL FACIAL PALSY IN THE EARLY STAGE

Objective:To observe the correlation between needling stimulation quantity and the therapeutic effect of acupuncture in the treatment of early stage of peripheral facial palsy. Methods: Sixty three peripheral facial palsy patients were randomized into treatment group (n=33) and control group (n=30). In treatment group, Taiyang (EX HN 5), Jingming (BL 1) and Hegu (LI 4) were punctured with gauge 36 acupuncture needles and stimulated with light twirling reinforcing method (about 200 times/min), the acupuncture needles were retained for 20 min. In addition, moxibustion was also applied to Fengchi (GB 20) and Qianzheng (EX HN 17) following puncturing them with gauge 30 filiform needles. In control group, conventional twirling reducing method (about 60 times/min) was applied to Yangbai (GB 14), Cuanzhu (BL 2), Sizhukong (TE 23), etc., following puncturing them with gauge 28 filiform needles. Additionally, thermal needle was applied to Fengchi (GB 20), Yifeng (TE 17) and Jiache (ST 6), with the needles retained for 40 min. Results: Following 10 days’ treatment, of the 33 and 30 cases in treatment and control groups, 21 (63.0%) and 12 (40.0%) were cured, 7(21.1%) and 5 (16.7%) had remarkable improvement, 4 (12.1%) and 9 (30.0%) were effective, and 1 (3.0%) and 4 (13.3%) failed in the treatment, with the cure plus markedly effective rates being 84.8% and 56.7% respectively. Statistical analysis shows that in acupuncture treatment of early stage of facial palsy, light stimulation is superior to that of heavy stimulation in the therapeutic effect.

Misdiagnosis of Facial Nerve Palsy: A Case Report of Sporadic Vestibular Schwannomas (Non-NFM2) Causing Facial Nerve Palsy Be Misled by Bell’s Palsy in a Child

We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.

The Anti-Inflammatory Effects of NaCl with KCl as a Potent Graphene Exfoliator in a Patient with Guillaine-Barré Syndrome and Facial Nerve Palsy

Guillain-Barré syndrome is a rare but fatal autoimmune disease of unknown origin. Infectious disease is the most common etiology of Guillain-Barré syndrome. We had a 75-year-old female patient with Guillain-Barré syndrome and a 90-year-old male patient with facial nerve palsy admitted to our hospital. Both patients experienced recovery from early Guillain-Barré syndrome and peripheral facial nerve palsy after receiving intravenous infusion of NaCl with KCl solution and taking vitamin C.

Therapeutic Efficacy Observation on Mild Lifting and Superficial Pulling Point-towards-point Needling for Intractable Facial Palsy

Objective: To observe and compare the clinical effects of combining mild lifting and superficial pulling point-towards-point needling and point injection and integrated standard electroacupuncture(EA) with intramuscular injection of Mecobalamin for intractable facial palsy. Methods: Eighty cases with intractable facial palsy were randomized into a treatment group and a control group, 40 in each group. Cases in the treatment group were treated with mild lifting and superficial pulling point-towards-point needling Xiaguan(ST 7) coupled with point injection of Mecobalamin. Cases in the control group were treated with standard EA coupled with intramuscular injection of Mecobalamin. After three courses of treatment, the between-group comparisons of Portmann scores and clinical effects were conducted. Results: After three courses of treatment, the Portmann scores in both groups were higher than the scores before treatment(P<0.01); the Portmann score in the treatment group was higher than that in the control group(P<0.05) and the total effective rate in the treatment group was higher than that in the control group(P<0.05). Conclusion: Combining mild lifting and superficial pulling point-towardspoint needling and point injection of Mecobalamin could obtain better effect for intractable facial palsy than standard EA coupled with intramuscular injection of Mecobalamin.

Clinical Observation of Combined Acupuncture and Medications in Treating 90 Cases of Facial Palsy

Peripheral facial palsy, namely Bell palsy, is one of the common diseases in the department of acupuncture. Facial palsy, popularly called wry mouth and eye, is primarily manifested by the motor malfunction of the muscles of the expression on the affected side. The author adopted combined acupuncture and medications to treat 90 cases of facial palsy from June 2005 to June 2007, and attained good effects. It is now reported as follows.

Awareness of Hail Region Population about Facial Nerve Palsy (Seventh Cranial Nerve Palsy)

Background: Facial nerve palsy (seventh cranial nerve palsy) is a common neurological problem. The etiology is not fully understood but it is thought to be due to injury or compression throughout the seventh cranial nerve course. The study aimed to evaluate the awareness of the Hail region population about facial nerve palsy, its risk factors, methods of treatment, and prognosis. Methodology: This cross-sectional descriptive study was conducted in the Hail region from March to June 2022. The study involved 224 participants in the age group 18 - 65 years and data was collected through Google self-administered questionnaire. Results: 65.2% of the participants were 18 - 25 years, 20.1% were 26 - 35 years and 14.7 were above 35 years. 91.9% think that exposure to cold air is the leading cause followed by viral infections (30.4%), stroke (27.6%), and genetic factors (13.8%). diabetes (8.5%), evil eye (7.1%), magic (4%), pregnancy (0.4%) and vitamins deficiency (0.4%). 92% of participants think that facial nerve palsy is not contagious and 8% have no clear idea. 89.7% think that facial nerve palsy is curable, 83.9% think that physiotherapy is the treatment of choice, 94.6% agree that early medical assessment is essential for good outcomes and 92.9 believe that avoidance of cold air is the best method of prevention. Conclusion and Recommendations: The majority of participants show poor awareness regarding the etiology and the preferable treatment of facial nerve palsy. Public medical education and further wider studies are highly recommended.

Recovery from Bell’s palsy after treatment using uncultured umbilical cord-derived mesenchymal stem cells:A case report

BACKGROUND Bell’s palsy is an idiopathic facial palsy with an unknown cause,and 75%of patients heal spontaneously.However,the other 25%of patients continue experiencing mild or severe disabilities,resulting in a reduced quality of life.Currently,various treatment methods have been developed to treat this disease.However,there is controversy regarding their effectiveness,and new alternative treatments are needed.CASE SUMMARY The patient suffered from left-sided facial paralysis due to Bell’s palsy for 7 years.The patient received an uncultured umbilical cord-derived mesenchymal stem cell transplant eight times for treatment.After follow-up for 32 mo,the paralysis was cured,and there was no recurrence.CONCLUSION Uncultured umbilical cord-derived mesenchymal stem cell transplantation may be a potential treatment for patients with Bell’s palsy who do not spontaneously recover.

Facial reanimation with interposition nerve graft or masseter nerve transfer:a comparative retrospective study

Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of these two procedures has yet been reported.In this two-site,twoarm,retrospective case review study,32 patients were included.Of these,17 patients(eight men and nine women,mean age 42.1 years)underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute,School of Medicine,Shanghai Jiao Tong University,China,and 15 patients(six men and nine women,mean age 40.6 years)underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital,China.More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair(15/15 vs.12/17).The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft.These findings suggest that masseter nerve transfer results in strong oral commissure excursion,avoiding obvious synkinesis,while an interposition nerve graft provides better resting symmetry.This study was approved by the Institutional Ethics Committee,Shanghai Ninth People's Hospital,China(approval No.SH9 H-2019-T332-1)on December 12,2019.

Acupuncture and vitamin B_(12) injection for Bell's palsy:no high-quality evidence exists

OBJECTIVE： To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell＇s palsy. DATA RETRIEVAL： A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words ＂Bell＇s palsy or idiopathic facial palsy or facial palsy＂ and＂acupuncture or vitamin B12 or methylcobalamin＂. STUDY SELECTION： All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell＇s palsy were included in the me- ta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk （RR） with 95% confidence interval （C/） using the fixed effect model of Review Manager. MAIN OUTCOME MEASURES： Incomplete recovery rates were chosen as the primary outcome. RESULTS： Five studies involving 344 patients were included in the final analysis. Results showed that the incomplete recovery rate of Bell＇s palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang （EX-HN5）, Jiache （ST6）, Dicang （ST4） and Sibai （ST2）. The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Belrs palsy （RR = 0.71, 95%CI： 0.58-0.87; P = 0.001）, this result held true when 8 patients lost to follow up in one study were included into the analyses （RR = 0.70, 95%CI： 0.58-0.86; P = 0.0005）. In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup （P = 0.024）. There was no significant dif- ference in the incomplete recovery rate by subgroup analysis on drug types and treatment period. Most of the included studies were moderate or low quality, and bias existed. CONCLUSION： In patients with Bell＇s palsy, acupuncture combined with vitamin 812 can reduce the risk of incomplete recovery compared with acupuncture alone in our meta-analysis. Because of study bias and methodological limitations, this conclusion is uncertain and the clinical appli- cation of acupuncture combined with vitamin B12 requires further exploration.

Facial nucleus up-regulation of brain-derived neurotrophic factor mRNA following electroacupuncture treatment in a rabbit model of facial nerve injury

BACKGROUND： The effect of acupuncture treatment on peripheral facial nerve injury is generally accepted. However, the mechanisms of action remain poorly understood. OBJECTIVE： To validate the effect of acupoint electro-stimulation on brain-derived neurotrophic factor （BDNF） mRNA expression in the facial nucleus of rabbits with facial nerve injury, with the hypothesis that acupuncture treatment efficacy is related to BDNE DESIGN, TIME AND SETTING： Peripheral facial nerve injury, in situ hybridization, and randomized, controlled, animal trial. The experiment was performed at the Laboratory of Anatomy, Heilongjiang University of Chinese Medicine from March to September 2005. MATERIALS： A total of 120 healthy, adult, Japanese rabbits, with an equal number of males and females were selected. Models of peripheral facial nerve injury were established using the facial nerve pressing method. METHODS： The rabbits were randomly divided into five groups （n = 24）： sham operation, an incision to the left facial skin, followed by suture; model, no treatment following facial nerve model establishment; western medicine, 10 mg vitamin B1, 50 ug vitamin B12, and dexamethasone （2 mg/d, reduced to half every 7 days） intramuscular injection starting with the first day following lesion, once per day; traditional acupuncture, acupuncture at Ytfeng, Quanliao, Dicang, Jiache, Sibai, and Yangbai acupoints using a acupuncture needle with needle twirling every 10 minutes, followed by needle retention for 30 minutes, for successive 5 days; electroacupuncture, similar to the traditional acupuncture group, the Yifeng （negative electrode）, Jiache （positive electrode）, Dicang （negative electrode）, and Sibai （positive electrode） points were connected to an universal pulse electro-therapeutic apparatus for 30 minutes per day, with disperse-dense waves for successive 5 days, and resting for 2 days. MAIN OUTCOME MEASURES： Left hemisphere brain stem tissues were harvested on post-operative days 7, 14, 21, and 28 under a dissecting microscope. Neuronal appearance in the facial nucleus was observed following Nissl staining. BDNF mRNA expression in the facial nucleus was determined using in situ hybridization. RESULTS： A total of 120 rabbits were included in the final analysis. In the model group, the nucleolus was asymmetric with cell body swelling, and the number of Nissl bodies decreased. With increasing time, there were more Nissl bodies in the western medicine, traditional acupuncture, and electroacupuncture groups, in particular the electroacupuncture group. However, the number of Nissl bodies remained less than in the sham operation group. The number of BDNF-positive neurons in the facial nucleus was significantly greater in the western medicine, traditional acupuncture, and electroacupuncture groups, compared with the model group （P 〈 0.01）. The number of BDNF-positive neurons in the facial nucleus of reached a minimum in the electroacupuncture group on post-surgery day 21, and increased by day 28, but remained less than control levels. CONCLUSION： Electroacupuncture at acupoints increased BDNF expression in the facial nucleus, alleviated neuronal injury in the facial nucleus, and promoted facial nerve regeneration. The effect was superior over traditional acupuncture and western medicine.

Metaphysical Energy Therapy in the Treatment of Cranial Nerve Palsies with Special Reference to Bell’s Palsy

Neuropathy, or nerve injury, is a severe and common impediment of diabetes. Studies evaluate that 50% of people with diabetes will develop neuropathy. Diabetic nerve injury is impairment of a single solitary nerve (also named mononeuropathy). Com- monly 2 cranial nerves Viz., cranial nerve VII and cranial nerve VI are involved in facial nerve palsies. The former one is called Bell’s palsy and is acute Lower Motor Neuron facial nerve paralysis (>80%) causing an inability to control facial muscles on the affected side. The later one is sixth nerve palsy, (the abducens nerve), which is responsible for triggering contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye resulting in double vision on the affected side. In recent times, we have found to our amazement, rapid restoration of normalcy within a few hours to a few days, of Cranial Nerve palsies in diabetic subjects at our centre. We are presenting a group of cases having Type2DM over different time periods from 6 to 20 years and those who suddenly suffered facial nerve palsy and they came to VHSDRC for treatment. They were started on the new modality called the Dynamic Acupuncture Mediated Meta-physical Energy Therapy (DAMM Therapy), to recover from the facial palsy. The DAMM therapy is a unique novel way of infusing and transferring healing energy from the therapist to the patient. Within 2 - 7 sittings of DAMM therapy patients showed 75% - 100% improvement in their clinical condition.

Facial nerve hemangiomas: A review

Facial nerve hemangiomas are rare benign vascular tumors with primary symptoms including progressive facial nerve palsy and hearing loss. They can involve various segments of the facial nerve, especially the geniculate ganglion （G.G.）. Preoperative MRI and CT imagining is of great importance for early diagnosis of such lesions. The most accepted treatment for facial nerve hemangiomas is surgical excisiont and the type of approach depends on tumor location, preoperative bearing level and tumor size. In consideration of the difficulties in differential diagnosis, otologists should pay attention to avoid missed or incorrect diagnosis in hemangiomas of facial nerve.

Imaging traumatic facial nerve injuries:a narrative review of current strategies and future directions for cranial nerve imaging

Traumatic facial nerve injuries can result in temporary or permanent loss of function.Restoration of facial expression may occur spontaneously or require surgical intervention.Although thorough examination and history can localize the site of facial nerve damage,it can be difficult to predict if and when recovery will occur.This is salient because the window for optimal outcomes from surgical re-neurotization can be as short as 1 to 2 years,after which functional loss may be irreversible.It is essential to offer patients the most appropriate treatment plan based on prognosis,and imaging plays an essential role in localizing the site and morphology of nerve injury.Multiple imaging modalities have been used to evaluate the facial nerve,including computed tomography(CT)and,more recently,advanced magnetic resonance imaging(MRI)and ultrasound(US).CT and MRI are more commonly implemented;however,Diffusion tensor tractography,high-resolution US,and functional US are gaining traction for studying cranial nerve pathology.Until recently,the morphology of facial nerve and other cranial nerve injuries could only be inferred using non-invasive diagnostic techniques.With the advent of newer imaging technologies and techniques to examine nerves,more refined assessment and prognostic information is now possible.This article reviews up-to-date cranial nerve imaging techniques from the last ten years and explores future avenues for facial nerve imaging.

The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

Objectives: Necrotizing external otitis(NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.Methods: Retrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns(group A) or complex spreading patterns(group B) as diagnosed by CT.Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results: 41 NEO patients were included, of which 27 patients belonged to group A(66%). The diseaserelated mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII(42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A(28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0(IQR 6.0-19.5) months.Conclusion: NEO is a severe disease, with significant mortality and morbidity(cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies(N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.

Multiple cranial nerve palsies with small angle exotropia following COVID-19 mRNA vaccination in an adolescent:A case report

BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed,raising public concerns regarding the side effects of immunization,as the incidence of ease.Although many adverse events following the coronavirus disease 2019(COVID-19)vaccine have been reported,neurological complications are relatively uncommon.Herein,we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.CASE SUMMARY A previously healthy,14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead,and pain in the right cheek.She had received second dose of the COVID-19 mRNA vaccine(Pfizer-BioNTech)18 days before onset of symptoms.She was diagnosed with Bell’s palsy and prescribed a steroid(1 mg/kg/day methylprednisolone)based on symptoms and magnetic resonance imaging findings.However,the next day,all sense of taste was lost with inability to swallow solid food;the gag reflex was absent.Horizontal diplopia was also present.Due to worsening of her condition,she was given high-dose steroids(1g/day methylprednisolone)for 3 days and then discharged with oral steroids.Improvement in the symptoms was noted 4 days post steroid treatment completion.At the most recent follow-up,her general condition was good with no symptoms except diplopia;ocular motility disturbances were noted.Hence,prism glasses were prescribed for diplopia relief.CONCLUSION Small-angle exotropia was observed in the facial,trigeminal,and glossopharyngeal nerve palsies,in our patient.The etiology of this adverse effect following vaccination was thought to be immunological.

Therapeutic Effect Analysis on Combined Acupuncture and Medication for Peripheral Facial Paralysis

Objective： To investigate the therapeutic efficacy of combined acupuncture and medication for peripheral facial paralysis. Methods： Sixty-six cases with peripheral facial paralysis were randomly allocated into a treatment group and a control group, 33 cases in each group. The cases in the treatment group were treated with combined electroacupuncture and Chinese medicine formula, while the cases in the control group were treated by electroacupuncture alone. Results： The recovery rate in the treatment group was significantly higher than the control group （P〈0.05）. In addition, the time length for recovery in the treatment group tended to be shorter than the control group. Conclusion： Combined acupuncture and medication can obtain better effect than electroacupuncmre alone for peripheral facial paralysis.