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.

Bilateral Peripheral Facial Paralysis Combined with HIV Meningitis During Acute HIV-1 Infection: A Case Report

Here we reported a Chinese case of bilateral peripheral facial paralysis(PFP) in human immunodeficiency virusc(HIV) infected population. A 38-year-old homosexual male patient was referred to our hospital for bilateral facial paralysis. 21 days prior to admission he had developed high fever, chills, headache, fatigue, general malaise, nausea and vomiting. Neurological examination revealed bilateral ptosis of lower lip and cheeks, as well as failure of bilateral eyes closure. Analysis of cerebrospinal fluid(CSF) revealed pleocytosis, a marked rise of micro total protein and a marked rise of intrathecal lgG synthesis. The result of HIV-1 serology was positive by ELISA and that was confirmed by western blot. His CD4^+ cell count was 180 cells/mm^3. HIV-1 viral load in CSF was almost 10 times higher than that in plasma. The patient's condition improved steadily and experienced complete resolution of bilateral PFP after 2 months.

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

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.

80 CASES OF PERIPHERAL FACIAL PARALYSIS TREATED BY ACUPUNCTURE WITH VIBRATING SHALLOW INSERTION

Eighty cases of peripheral facial paralysis were treated by acupuncture with vibrating shallow insertion. The total effective rate was 98.75% and cure rate 88.75%. There was no significant difference in therapeutic effect as compared with the conventional electroacupuncture method (P > 0.5), suggesting that shallow puncture by vibratings can also yield satisfactory therapeutic results.

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.

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.

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.

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.

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.

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.

Effects of L-arginine on the recovery of traumatic facial paralysis and the expression of NOS in the facial nucleus in rats

Objective:To study the effects of NO precursor L-arginine on the recovery of traumatic facial paralysisin rats and the changes of constitutive NOS/inducible NOS in the facial nucleus. Methods: A small dose of L-arginine was intraperitoneally injected into rats with facial paralysis, and the recovery of facial paralysis was observedat different time point. Immunohistochemical ABC method was used to study the changes of NOS positive neuronsin facial nucleus. Results: The recovery of facial paralysis in L-arginine chronic treatment group was faster thanthat in the experimental control group and the constitutive NOS immunoreactivity was intensive in facial nucleus,but the inducible NOS immunoreactivity had no apparent difference in comparison with that of the experimentalcontrol group. Conclusion: L-arginine chronic treatment can increase the constitutive NOS expression in facial nucleus and prornote the recovery of traumatic facial paralysis.

CLINICAL ANALYSIS ON 100 CASES OF FACIAL PARALYSIS TREATED WITH ACUPUNCTURE

The paper reports that 100 cases of facial paralysis were treated with accupunc-ture on points Xiaguan (ST7), Jiache (ST6), Dicang (ST4), Yifeng (SJ17) and Hegu (LI4) mainly.Of them, 91 cases were cured 8 markedly improved and 1 improved. The total effective rate was100%.

TREATMENT OF PERIPHERAL FACIAL PARALYSIS WITH PICK-PRICK AND CONNECTING-ACUPUNCTURE

Peripheral facial paralysis may occur inall ages,but particularly in the young.Thedisease is characterized by a wry mouth andinability to close the eyes.For many years,the author used pick-prick andconnecting-acupuncture in treatment of thismalady with good therapeutic results,as re-ported in the following.

CLINICAL AND EXPERIMENTAL STUDIES OF LARGE AMPLITUDE ACTION POTENTIAL OF THE SUFFERED FACIAL MUSCLES IN INTRATEMPORAL FACIAL NERVE PARALYSIS

Objective. To testify the phenomenon that large amplitude action potential appears at the early stage of facial paralysis, and to search for the mechanism through clinical and experimental studies. Patients(animals) and methods. The action potentials of the orbicular ocular and oral muscles were recorded in 34 normal persons by electromyogram instruments. The normal range of amplitude percentage was found out according to the normal distribution. One hundred patients with facial paralysis were also studied. The action potentials of facial muscles were recorded in 17 guinea pigs before and after the facial nerve was compressed and the facial nerve was examined under electromicroscope before and after the compression. Results. The amplitude percentage of the suffered side to the healthy side was more than 153 percent in 6 of the 100 patients. Large amplitude action potential occured in 35 per cent guinea pigs which were performed the experiment of facial nerve compression. Electromicroscopic examination revealed separation of the lammae of the facial nerve’s myelin sheath in the guinea pigs which exhibited large amplitude action potential. Conclusion. The facial nerve exhibited a temporary over excitability at the early stage of facial nerve injury in some patients and guinea pigs. If the injury was limited in the myelin sheath, the prognosis was relatively good.

CLINICAL OBSERVATION ON TREATMENT OF 120 CASES OF PERIPHERY FACIAL PARALYSIS WITH PENETRATION NEEDLING

In the present study, the therapeutic effect of penetration needling was observed in 120 cases facial paralysis patients and compared with that of the routine needling in another 105 cases. Results showed that though no significant difference was found between these two groups in the therapeutic effect, the acupoints used were fewer in penetration needling group and its effect on tear and posterior auricular pain was superior to that of routine needling.