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.

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.

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.

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.

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.

Acupuncture Treatment of Facial Paralysis Caused by Craniocerebral Trauma in 50 Cases

Cooperating with doctors in the Department of Brain Surgery, the author have treated 50 cases of facial paralysis caused by craniocerebral trauma in recent 3 years. The results are reported as follows.

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.

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 ANALYSIS ON INTEGRATED TREATMENT OF 2240 CASES OF PERIPHERAL FACIAL PARALYSIS BY STAGES IN PLATEAU REGION

Objective. To observe the therapeutic effect of integrated treatment of peripheral facial paralysis by stages in Qinghai plateau area. Methods： A total of 2 240 cases of peripheral facial paralysis treated with integrated approaches by stages were assigned to treatment group, and other 75 cases treated with acupuncture therapy assigned to control group. In treatment group, patients were treated with 1 ） medication （ Prednisone, Dipazol, etc） and TDP （“special electromagnetic spectrum”） plus ultrashort irradiation in the early stage;2） TDP plus ultrasonic wave irradiation and acupuncture of Yangbai （阳白 GB 14） to Yuyac （鱼腰EX-HN 4, penetration needling）, etc in the medium stage; 3） medium-frequency irradiation and electroacupuncture （EA） of muscle motor joints and acupoints （GB-14, etc）. Patients of control group were treated with conventional acupuncture therapy （GB-14, etc）. Results： After treatment, of the 2 240 patients in treatment group, 2 072 （92.5%） were cured, 120 （5.3%） effective, 33 （ 1.5% ） improved, and 15 （0.7%） failed. The total effective rate was 99.3%. Of the 75 cases in control group, 46 （61.3%） were cured, 16 （21.3%） effective, 9 （12.0%） improved, and 4 （5.4%） ineffective. The total effective rate was 94.6%. The cure rate and the total effective rate of treatment group were significantly higher than those of control group respectively （x^2=29.379, P〈0.01; x^2 =5. 716, P〈0. 025）. Conclusion： The therapeutic effect of integrated approaches （medication, acupuncture, electromagnetic ＋ ultrashort wave ＋ ultrasonic wave ＋ medium-frequency wave irradiation） is significantly superior to that of simple acupuncture therapy in treating peripheral facial paralysis.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

SURGICAL TREATMENT OF PERIPHERAL FACIAL PARALYSIS

The facial nerve passes through the temporal bone and is the longest nerve that travels in a bony canal with a complex course and high susceptibility to injury.When facial nerve becomes swollen from insults such as trauma, inflammation, tumor or iatrogenic injury, its distal

Traditional Chinese Medicine nursing protocols for facial paralysis

Facial paralysis is defined as severe or complete loss of facial muscle motor function possibly due to peripheral or central lesions.Currently,there are no effective treatment modalities for facial paralysis in western medicine.In Traditional Chinese Medicine(TCM),it is believed to be associated with malnutrition of facial muscles caused by qi stagnation and blood stasis due to wind-cold invasion.This article primarily investigated the key points of common syndromes,TCM nursing methods and healthy guidance of facial paralysis,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.

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.

PERIPHERAL FACIAL PARALYSIS TREATED BY MULTI-DIRECTIONAL NEEDLING

Objective：To search for an effective therapy in treating peripheral facial paralysis. Methods： One hundred and eight patients were randomly divided into treatment group （n = 68） and control group （n = 40）. The multi-directional needling technique was used by selecting Jiache （颊车 ST 6）, Yangbai （阳白 GB 14） and Dicang （地仓 ST 4） in the treatment group, and the traditional acupuncture technique with conventional needle selection was used in the control group. The treatment was given once daily with 10 treatments constituting a therapeutic course, and 2 courses of treatment were given in both the groups. Results： After the treatment, of the 68 and 40 cases in treatment and control groups, 56 （82.3%） and 28 （70.0%） were cured, 11 （16.2%） and 8 （20.0%） improved in clinical symptoms and signs, 1 （1.5%） and 4 （10.0%） failed, with the total effective rate being 98.5% and 90.0% respectively, and the therapeutic effect of treatment group was significantly superior to that of control group （ P 〈 0.05）. Conclusion： The multi-directional needling is an effective therapy for treating peripheral facial paralysis.