Peripheral Facial Paralysis in People Living with Human Immunodeficiency Virus (HIV)

Introduction: Peripheral facial palsy (PFP) is a frequent reason for ENT consultations. It is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to describe the diagnostic and therapeutic aspects and to establish the correlation between PFP and HIV in our context. Patients and Method: This was a retrospective descriptive study conducted in the ENT and CFS department of the HIAOBO, covering the medical records of patients hospitalized for taking a PFP on HIV terrain from January 1, 2016 to December 31, 2020. Results: The study involved 17 patients, 10 men (59%) and 7 women (41%), a sex ratio of 1.4. The average age was 39 years with the extremes of 11 and 69 years. Shopkeepers reported 9 cases (53%). The reason for consultation was facial asymmetry in 11 cases (100%). The delay in consultation during the first week was 82.4%. Clinical signs were unilateral facial asymmetry, the opening of the palpebral fissure and lacrimation. All patients received medical treatment for PFP and HIV. Evolution was favorable, with complete recovery and no sequelae in 82.4% of cases. Surgery was performed in one case. Conclusion: PFPs are common in HIV infection. Diagnosis is clinical and management is multidisciplinary. Progression depends on the length of time taken to treat the disease.

Literature study on clinical treatment of facial paralysis in the last 20 years using Web of Science Comparison between rehabilitation, physiotherapy and acupuncture

BACKGROUND： Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE： The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. DESIGN： Bibliometric approach. DATA RETRIEVAL： A bibliometric analysis based on the publications on Web of Science was performed using key words such as ＂facial paralysis＂, ＂rehabilitation＂, ＂physiotherapy＂ and ＂acupuncture＂. INCLUSIVE CRITERIA： （1） Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy （e.g. exercise, electro-stimulation） and other rehabilitation methods; （2） researches on human and animal fundamentals, clinical trials and case reports; （3） Article types： article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. （4） Publication year： 1992-2011 inclusive. Exclusion criteria： （1）Articles on the causes and diagnosis on facial paralysis; （2） Type of articles： correction; （3） Articles from following databases： all databases related to social science and chemical databases in Web of Science. MAIN OUTCOME MEASURES： （1） Overall number of publications; （2） number of publications annually; （3） number of citations received annually; （4） top cited paper; （5） subject categories of publication; （6） the number of countries in which the article is published; （7） distribution of output in journals. RESULTS： Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject ＂facial paralysis treatments using rehabilitation＂ during the first decade of the 21 st century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated by rehabilitation in the past two decades, far more than the output of physiotherapy treatment. Physiotherapy treatment scored only 25 articles including acupuncture treatment, with over 80% of these written by Chinese researchers and clinicians. Ranked by regions, USA is by far the most productive country in terms of the number of publications on facial paralysis rehabilitation and physiotherapy research. Seeing from another angle, the journals that focus on otolaryngology published the most number of articles in rehabilitation and physiotherapy studies, whereas most acupuncture studies on facial paralysis were published in the alternative and complementary medicine joumals. CONCLUSION： Study of facial paralysis remains an area of active investigation and innovation. Further clinical studies in humans addressing the use of growth factors or stem cells continue to successful facial nerve regeneration.

REVIEW ON ACUPUNCTURE TREATMENT OF PERIPHERAL FACIAL PARALYSIS DURING THE PAST DECADE

Facial paralysis or Bell’s palsy is acommon disease that frequently attacksadults aged 20--40 years, especially women.According to traditional Chinese medicine,the pathogenesis is believed to be due to in-vasion of the channels and collaterals

Facial nerve paralysis in children

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital(due to delivery traumas and genetic or malformative diseases) or acquired(due to infective,inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.

An Experimental Study on the Optimal Timing for the Repair of Incomplete Facial Paralysis by Hypoglossal-facial‘Side'-to-side Neurorrhaphy in Rats

Objective To investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial ‘side＇-to-side neurorrhaphy in rats. Methods A total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups（n = 6 each） that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement. Results At 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed. Conclusion The results of this study demonstrated that hemi HN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.

A SURVEY OF ACUPUNCTURE TREATMENT FOR PERIPHERAL FACIAL PARALYSIS

Peripheral facial paralysis,a commondisease referring mainly to Bell’s palsy,iscaused by peripheral nerve malfunction dueto the effect of cold and wind,the exactcause of which still remains unascertained.

ELECTRIC NEEDLE THERAPY FOR PERIPHERAL FACIAL PARALYSIS

From 1986 to 1995, the author treated 60 cases of peripheral facial paralysis, of which 50 cases were treated with electric needles and 10 cases in the control group with filiform needles.

CLINICAL OBSERVATION ON ACUPUNCTURE TREATMENT OF PERSISTENT FACIAL PARALYSIS

Persistent facial paralysis is present after failure of six months’ treatment of peripheral facial paralysis, with sequelae such as deviation of the mouth and eye. Since 1983, the intermittent lifting and the uniform reinforcing-reducing methods have been applied for comparison in the treatment of 310 cases of persistent facial paralysis, with satisfactory results reported as follows.

The research progress of acupuncture and moxibustion in the treatment of peripheral facial paralysis

As a common and frequently-occurring disease in clinic,peripheral facial paralysis is worth paying attention to.In fact,as one of the methods for the treatment of peripheral facial paralysis,acupuncture has been widely promoted and applied in clinic,and has been recognized by doctors at home and abroad.However,there are many other factors that affect the curative effect in clinic due to their different operating methods.Therefore,there are still many disputes in the treatment of peripheral facial paralysis.The relevant literatures in recent years were searched and consulted in order to understand the current situation and provide routine treatment methods for clinical acupuncturists to treat this disease.And we intended to analyze and introduce from acupuncture manipulation,warm acupuncture,electroacupuncture,giant acupuncture,fire acupuncture,acupuncture combined with massage,acupuncture timing and other treatments,and different classification of acupuncture points and methods.

METHODOLOGICAL EVALUATION ON CLINICAL RESEARCH LITERATURE OF ACUPUNCTURE TREATMENT OF FACIAL PARALYSIS

Objective: To try to give an objective evaluation on the clinical research situation about acupuncture treatment of facial paralysis in the past 50 years and try to provide a possible evidence for clinical practice. Methods: All papers are searched and assessed according to the international standards and clinical epidemiology. Results: There is no systematic review (SR) on acupuncture treatment of facial palsy in a total of 1021 articles enlisted in the present paper. Comparing with the quantity of the descriptive studies and expert opinions (constituting 84.84%), that of the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) is smaller (constituting 15.16%), besides, the quality of RCTs and CCTs is unsatisfactory. Conclusion: At present, the quantity and quality of studies with RCTs about acupuncture treatment of facial paralysis can’t meet the need of clinical practice, and in order to improve the therapeutic effect, a higher quality of RCTs and SR is required.

Facial paralysis in cerebral infarction:A case of misdiagnosis and literature review

Facial paralysis can be classified as central or peripheral facial paralysis based on the location of the underlying lesion,both of which demonstrate facial motor dysfunction.In the currently report,a patient admitted to the department of otology,First People’s Hospital of Qinhuangdao,presented with facial asymmetry as the initial symptom of a cerebral infarction and was first misdiagnosed as peripheral facial paralysis.The case is reported as follows.

Combined Subtemporal-Supralabyrinthine Approach to Geniculate Ganglion for Management of Facial Paralysis in Temporal Bone Fracture

Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann（HB） grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.

THE STUDY ON THE RELATION BETWEEN THE LOCATION OF NERVE LESION IN PERIPHERAL FACIAL PARALYSIS AND THE THERAPEUTICAL EFFECT OF ACUPUNCTURE

Due to the difference of the plane of facial nerve lesion,facial paralysis can be classifiedinto nudear paralysis,paralysis of cerebellopontine angle,Hunt’s palsy,Bell’s palsy and simple facialneuritis.The authors treated 78 cases of the of the latter 3 types,compared the therapeutical effect after 2courses of treatment,and meanwhile made dynamic electromyographic observation between the tragusand the quadrate musde of upper lip for those with Bell’s palsy and Hunt’s palsy.The result showsthat acupuncture has a fair effect in treating peripheral facial paralysis and simple facial neuritis andthe myoelectric recovery in Bell’s palsy is quicker than that in Hunt’s palsy.It is suggested that thehfeher the pane of the facial nerve lesion is,the more unsatisfactory the effect is,and the effect ismore favorable otherwise.

CLASSIFICATION, PROGRESSIVE STAGE AND COMBINED TREATMENT OF PERIPHERAL FACIAL PARALYSIS

A combined method using acupuncture,Chinese herbs and Western medicine inthe treatment of peripheral facial paralysis is formulated from the author’s clinical experience duringmore than 20 years period.Two stages and four types are divided separately according to the develop-ment of the disorder and the lesion level of the facial nerve。which are different from the classificationsin the common textbooks.Out of the whole series of 718 cases,99.58％of the patients got cured andno one had been treated ineffectively.

CLINICAL RESEARCH OF LAMB'S FACIAL PARALYSIS TREATED BY COMBINATION OF ACUPUNCTURE AND MEDICINE

Lamb’s facial paralysis is caused by tick-borne spirochete damaging the facialnerve, its symptom is wry mouth with distorted eye. This paper reported that serum antibody in 46cases of Lamb’s disease had been tested by indirect immuofluorescence since 1991 and the positive ratewas 43.48%. 20 cases out of them were treated by combination of acupuncture and medicine and thecure rate was 85%, the total effective rate was 100%.

TWO HUNDRED CASES OF FACIAL PARALYSIS TREATED BY ACUPUNCTURING DIAOXIAN POINT

The present paper is about the treatment of facial paralysis by acupuncturingDiaoxian point dominantly.Two hundred cases of facial paralysis were treated by this method,the totaleffective rate was 100％,and the cure rate 93％.This therapy is simple,easy and economical,without side-effects.It should be chosen first for treatment of facial paralysis in clinic.

OBSERVATION ON THE EFFECT OF SHALLOW NEEDLING FOR TREATMENT OF PERIPHERAL FACIAL PARALYSIS IN 80 AFRICANS

This paper is a summary of 150 cases of facial paralysis in African black people treated with shallow needling and mild needling manipulation. After 3 courses of treatment, of the 80 cases in the shallow-needling group, 71 (88. 8% ) were cured, 5 (6. 3% ) had marked improvement, 3 (3. 7% ) had improvement and 1 (1. 2% ) failed; Of the 70 cases in traditional-needling group, 61 (87. 1 % ) were cured, 6 (8. 6% ) had evident improvement, 2 (2. 9% ) had improvement and 1 (1. 4 % ) had no striking change. Statistical analysis showed no significant difference between the two groups in the therapeutic effect (P >0. 5 ), indicating both the traditional needling method and shallow needling were effective in treatment of facial paralysis in black people. In addition, earlier treatment was very important in healing facial palsy; and the cure rate was higher in younger patients ard those with light severity.

Use of steroids for facial nerve paralysis after parotidectomy:A systematic review

AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating postparotidectomy facial nerve palsy(FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE(from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP postparotidectomy is transient. Preoperative factors(size of tumour and malignancy), intraoperative factors(extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur.CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term followup are required to increase scientific evidence.

TWO-STEP REGULATION METHOD OF ACUPUNCTURE IN THE TREATMENT OF INTRACTABLE FACIAL PARALYSIS OBSERVATION ON 96 CASES

Two step regulating acupuncture therapy was employed in the treatment of 96patients with intractable facial paralysis and the therapeutic effects of the method is compared withthat in 40 patients in control.In the first step,strong regulating acupuncture was applied at Meixin(EXtra),upper Taiyang (EX-HN 5) and Xiaguan (ST 7) points in the affected face.In the secondstep,weak regulating acupuncture was used at Dicang (ST 4) and Sibai (ST 2) points in the healthface.It was revealed that among the 96 patients,37 cases (38. 5%) were cured,57 cases (59. 4%)markedly improved,2 cases (2.1%) improved with a total effective rate of 100%.The effective ratewas statistically different (P【0. 005) from that in the control.The results indicate that the method issuperior to the ordinary manipulation in treating intractable facial paralysis.

Values of blink reflex and electroneurography in diagnosis of facial paralysis

BACKGROUND： The electrophysiological test was mainly achieved by the reaction of nerve fiber to electrical stimulus, usually expressed by the amplitude and latency. Blink reflex and electroneurography （ENOG） are widely applied in facial paralysis, the amplitude would step down, and the latency would prolong when the facial nerve was injured. OBJECTIVE： To compare the value of blink reflex and ENOG in the diagnosis of facial paralysis （Bell＇s palsy）. DESIGN： A controlled trial. SETTINGS： Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People＇s Hospital. PARTICIPANTS： The patients who had finished the tests of blink reflex （n =207） and ENOG （n =205） were selected from the Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People＇s Hospital from September 2001 to July 2003. After treatment for 4 weeks, the patients finished tests of blink reflex （n =207） and ENOG （n =205） were randomly divided into primary treatment group （n =68, 69）, acupuncture group （n =71, 66） and comprehensive treatment group （n =68, 70）, respectively. Approval was obtained from the ethic committee of hospital. METHODS： Patients in the primary treatment group and acupuncture group were treated with western medicine, acupuncture and moxibustion alone respectively, and those in the comprehensive treatment group were treated with acupuncture and moxibustion based on western medicine. The whole period of treatment was 4 weeks. The tests of blink reflex and ENOG were carried out using Japanese light and electricity MEB-2200 electromyogram/induced potential instrument for once before and after treatment respectively. The normal value of the latency period of wave RI was within 13 ms, and the difference was 1 - 1.2 ms between the left and right sides. MAIN OUTCOME MEASURES： The latency of wave RI of blink reflect and the latency and wave amplitude of ENOG on the affected and healthy sides before and after treatment were observed. RESULTS： Totally 207 and 205 patients received tests of blink reflex and ENOG, but 17 and 16 cases respectively did not finish the second measurement, finally 190 and 189 cases were involved in the analysis of results. The latencies of wave R 1 on the affected side after treatment were significantly longer than those before treatment （t = - 6.253, P 〈 0.01）; The latencies of wave RI on the normal side were in the normal range before and after treatment; The latencies of wave RI before treatment on the affected side was significantly longer than that on the normal side （t =- 5.896, P 〈 0.01）, but there were no significant differences between the affected and normal sides after treatment （P 〉 0.05）. It was indicated that the latencies of wave RI on the affected side had restored normally, and the blink reflex was improved obviously after treatment. The latency of ENOG on the affected side before treatment was significantly prolonged as compared with that on the normal side （t =2.247, P 〈 0.01）; After treatment, the difference between the affected and normal side became smaller, but remarkable significance still existed （t =10.810, P 〈 0.01）. In spite of the obvious improvement of affected side before and after treatment, there were still significant differences （t =- 8.110, P 〈 0.05）. The wave amplitude on the affected side was decreased after treatment, which was not significantly different from that before treatment （P 〉0.05）. CONCLUSION： After treatment of facial paralysis, blink reflect was greatly improved, there was an obvious hysteresis in the latency of ENOG. Therefore, blink reflect was better than ENOG in the early diagnosis, while ENOG was suitable for evaluating the prognosis. The ENOG examination was better than blink reflex at middle and late period.