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.

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.

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 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 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

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.

TREATMENT OF 46 CASES OF PERIPHERAL FACIAL PARALYSIS WITH HAND ACUPUNCTURE,MOXIBUSTION AND ELECTROACUPUNCTURE

In the present paper, the therapeutic effect of hand acupuncture, moxibustion and electroacupuncture (EA) is observed in the treatment of 46 cases of peripheral facial paralysis (treatment group) and compared with that of Western medicines (prednisone, Vitamin B1 and B12, dibazol) in other 42 facial palsy patients. Acupoints used are Fenchi (GB 20), Yifeng (TE 17), Taiyang (LR 3), Yangbai (GB 14), Cuanzhu (BL 2), Yingxiang (LI 20), Dicang (ST 4), Shuigou (GV 26), Chengjiang (CV 24), Xiaguan (ST 7) and Jiache (ST 6). Following 20 - 30 sessions of treatment, results show that the therapeutic effect of treatment group is significantly superior to that of Western medicine group and the therapeutic duration of the former group is shorter.

CLINICAL OBSERVATION ON STAGE-AIDED TREATMENT OF 62 CASES OF PERIPHERAL FACIAL PARALYSIS WITH ACUPUNCTURE,MOXIBUSTION AND CUPPING

Objective: To probe the best therapy for peripheral facial paralysis. Methods: A total of 122 cases of facial paralysis patients were randomized into treatment group (n=62, treating the disease by stages) and control group (n=60). For patients at the acute stage in treatment group, main point Yifeng (TE 17) was pricked first, followed by performing cupping and moxibustion, for patients at the resting stage, main point Hegu (LI 4) was punctured with reducing needling method, combined with other acupoints in the light of the concrete situations. For patients at the restoration stage, main point Zusanli (ST 36) was punctured with reinforcing method in combination with seven-star-needle tapping at the local affected region. Patients of control group were treated with routine method by puncturing Fengchi (GB 20), Yifeng (TE 17), Jiache (ST 6), Hegu (LI 4), Taichong (LR 3), etc.. The treatment was conducted once daily, with 10 days being a therapeutic course. Results: Following 3 courses of treatment, of the 62 cases in treatment group, 44 (70.9%) were cured, 12 (19.4%) had remarkable improvement in their symptoms and signs, 6 (9.7%) had amelioration, with the cure plus markedly effective rate being 90.3%; of the 60 cases in control group, 30 (50.0%) were cured, 12 (20.0%) had apparent improvement, 16 (26.7%) had amelioration, and the rest 2 (3.3%) failed in the treatment, with the cure plus markedly effective rate being 70.0%. Ridit analysis showed that the cure rate and cure plus markedly effective rate of treatment group were significantly higher than those of control group (P<0.05). Conclusion: Stage-aided acupuncture treatment is superior to routine treatment for facial palsy.

Peripheral facial paralysis treated with acupuncture-moxibustion by stages: a multi-central large-sample randomized controlled trial

Objective To explore the best intervention time of peripheral facial paralysis （Bell＇ s palsy） treated with acupuncture-moxibustion and the clinical superiority of acupuncture-moxibustion by stages. Methods Multi- central large-sample randomized controlled trial was carried out. Nine hundred cases of Bell＇ s palsy were randomly divided into 5 treatment groups, named as acupuncture by stages group, acupuncture by stages with moxibustion group, acupuncture by stages with electroacupuncture group, acupuncture by stages with line-puncture on muscle region of meridian group and acupuncture without stages group. Four sessions of treatment were required in each group. The clinical curative effects of groups were assessed by House-Brackmann Scale, Facial Disability Index Scale and Degree of Facial Nerve Paralysis Scale during the enrollment, after 4 sessions of treatment, and during 1 and 3 months of follow-up after treatment. The systematic analysis of curative effects was provided in view of the intervention time and nerve localization of disease separately. Results The cure rates of intervention treatment were 50.1% （223/445） in acute stage and 52.1% （162/311） in resting stage, superior to that of 25.9% （35/135） in recovery stage （both P〈0.001）. There was no statistically significant differences in comparison of curative effect in 5 solutions at the same stage （all P〉0.05）. The effect of treatment intervened at acute stage was superior to that at recovery stage in acupuncture by stages group and acupuncture without stages group （both P〈0.01）. There were statistically significant differences in curative effect of the localization above and below chorda tympani nerve in acupuncture by stages with line-puncture on muscle region of meridian group （P〈0.01）. The curative effect of the localization below chorda tympani nerve was superior to that above the nerve. Conclusion The best intervention time for Bell＇ s palsy is at acute stage and resting stage, meaning 1 to 3 weeks after occurrence. All 5 solutions are clinical superiorities to Bell＇s palsy. Under the condition of limited medical sources, the simple filiform needle puncture is recommended at acute stage. For the patients with the disorder above chorda tympani nerve, line-puncture on muscle region of meridian is not recommended.

Comparison on the therapeutic effect of acupuncture on 60 cases of peripheral facial paralysis at different stages

Objective To investigate the difference in the therapeutic effect of different methods in the treatment of peripheral facial paralysis （PFP） at different stages. Methods Sixty cases of PFP at different stages were divided into a treatment group and a control group according to the sequence for visit, and 30 patients were included in each group. The patients in the treatment group were treated by using drugs, acupuncture （shallow puncture and subexcite） and microwave therapy during the acute stage, and they were subjected to electroacupuncture （EA） （heavy stimulation and penetration needling）, acupoint injection, electrotherapy and massage during the convalescence stage. In contrast, the patients in the control group were treated simply with drugs, and the therapeutic methods during the convalescence stage were the same to those for the treatment group, and the therapeutic effect of the two groups was observed after three treatment courses. Results The total effective rate in the treatment group was 100.0% （30/30）, the cured rate after one treatment course was 48.2% （13/27）, the cured rate after two treatment courses was 44.4% （12/27）, and the cured rate after three treatment courses was 7.4% （2/27）. The total effective rate in the control group was 90.0% （27/30）, the cured rate after one treatment course was 5.5% （1/18）, the cured rate after two treatment courses was 27.8% （5/18）, and the cured rate after three treatment courses was 66.7% （12/18）. The therapeutic effect and the treatment courses for healing of the treatment group were significantly better than those in the control group （P0.05）. Conclusion the therapeutic effect of different therapeutic methods on PFP is remarkable.

Treatment of peripheral facial paralysis with acupuncture at Rényíng (人迎 ST 9) combined with stellate ganglion block:a randomized controlled trial

Objective To explore the best therapeutic method in the treatment of peripheral facial paralysis. Methods One hundred and twenty cases were randomized into a conventional acupuncture group [Yangbai （阳白 GB 24）, Sibai （四白 ST 2）, Yingxiang （迎香 LI 20）, etc.], a Renying （人迎ST 9） acupuncture group and an operation ＋ acupuncture group [acupuncture at ST 9 as the main acupoint and the stellate ganglion block （SGB）], 40 cases in each one. The treatment was given once a day, 7 treatments made one session. After 3 sessions of treatment, the latency and the amplitude of the direct stimulation evoked potential of the facial nerve （ENoG） were compared before and after treatment in three groups, as well as R2 and R2 values of blink reflex （BR）. The total clinical efficacy was assessed. Results The latency of ENoG was shortened and the amplitude was increased significantly in three groups. After treatment, ENoG latency was lower significantly in the operation ＋ acupuncture group as compared with that in the conventional acupuncture group （P〈0.05）. In the Renying （人迎 ST 9） acupuncture group, the amplitude of ENoG was increased as compared with P〈0.05）. After treatment in three groups, those in the other two groups （all R2 and R2 values were decreased significantly. The differences in R1 and R2 values in the Renying （人迎 ST 9） acupuncture group and the operation ＋ acupuncture group before and after treatment were bigger than those in the conventional acupuncture group （all P〈0.05）, and the difference in R2 value in the operation ＋ acupuncture group was bigger than that in the Renying （人迎 ST 9） acupuncture group （P〈O.05）. The clinical markedly effective and curative rate was 87.5% （35/40） in the operation ＋ acupuncture group, which was superior to 77.5% （32/40） in the Renying （）人迎 ST 9）acupuncture group and higher significantly than 65.0% （26/40） in the conventional acupuncture group （P〈0.05）. Conclusion Compared with the conventional acupuncture, the efficacy on peripheral facial paralysis is much better in the Renying （人迎 ST 9） acupuncture group and the operation ＋ acupuncture group. Moreover, the early reflex function of the damaged facial nerve is much better recovered in the operation ＋ acupuncture group as compared with that in the Renying （人迎 ST 9） acupuncture group.

基于寒地地域特点探析周围性面瘫的针灸治疗

周围性面瘫寒地高发,受寒地特殊的气候环境及寒地居民独特的生活方式影响,形成了寒地周围性面瘫极具地域特色的发病特点:脉络空虚,风邪侵袭,内外为患;寒邪稽留,血脉凝泣,肌肤失养;饮食偏嗜,痰湿盘踞,窜犯脉络。临床中医在诊病思路及施针方法上应基于寒地周围性面瘫患者的体质特点及其病邪特点,因地制宜、因人制宜,做到标本兼顾、审时度法与相因施针。

特定电磁波谱照射联合针灸治疗急性周围性面瘫的效果

目的探讨特定电磁波谱照射联合针灸治疗急性周围性面瘫的效果。方法选取江西省人民医院2022年6月至2023年3月收治的60例急性周围性面瘫患者作为研究对象,按照随机数字表法分为对照组(30例)与观察组(30例)。对照组采用口服西药治疗,观察组采用特定电磁波谱照射联合针灸治疗。比较两组患者的Portmann评分、临床疗效和患者满意度。结果中途脱落3例,实际完成57例,对照组28例,观察组29例。治疗前,两组患者的Portmann评分比较,差异无统计学意义(P>0.05)。治疗20 d后,两组患者的Portmann评分高于本组治疗前,差异有统计学意义(P<0.05);观察组的Portmann评分高于对照组,差异有统计学意义(P<0.05)。观察组的治疗总有效率为89.66%(26/29),高于对照组的64.29%(18/28),差异有统计学意义(P<0.05)。观察组的总满意率为96.56%,高于对照组的71.43%,差异有统计学意义(P<0.05)。两组患者均未发生严重不良反应。结论特定电磁波谱照射联合针灸治疗急性周围性面瘫疗效显著,可提高患者满意度,值得临床推广。

经筋刺法治疗周围性面瘫的疗效观察

目的观察经筋刺法治疗周围性面瘫的临床疗效及其对瞬目反射、面部肌电图、动脉分支血流动力学的影响。方法将120例周围性面瘫患者随机分为观察组和对照组,每组60例。观察组采用经筋刺法治疗,对照组采用常规针刺治疗。观察两组治疗前后瞬目反射、面部肌电图指标(R1、R2波及对侧R2’波潜伏期,口轮匝肌、眼轮匝肌、鼻肌潜伏期及患健侧波幅比值)、动脉分支血流动力学指标[患侧面动脉、下唇动脉、内眦动脉、上唇动脉收缩期峰值血流速度(peak systolic velocity,PSV)和血管阻力指数(resistance index,RI)]、面神经功能[House-Brackmann(H-B)]分级及面部残疾指数(facial disability index,FDI)各项评分(躯体功能及社会/行为功能评分)的变化情况,比较两组临床疗效。结果两组治疗后R1、R2波及对侧R2’波潜伏期和口轮匝肌、眼轮匝肌、鼻肌潜伏期均较同组治疗前显著缩短,口轮匝肌、眼轮匝肌、鼻肌患健侧波幅比值及患侧面动脉、下唇动脉、内眦动脉、上唇动脉PSV均显著升高,RI和FDI各项评分均显著下降,差异均具有统计学意义(P<0.05)。观察组治疗后R1、R2波及对侧R2’波潜伏期和口轮匝肌、眼轮匝肌、鼻肌潜伏期均明显短于对照组,口轮匝肌、眼轮匝肌、鼻肌患健侧波幅比值及患侧面动脉、下唇动脉、内眦动脉、上唇动脉PSV均高于对照组,RI和FDI各项评分均低于对照组,差异均具有统计学意义(P<0.05)。两组治疗后H-B分级与同组治疗前比较,差异均具有统计学意义(P<0.05)。观察组治疗后H-B分级与对照组比较,差异具有统计学意义(P<0.05)。观察组总有效率为96.7%,明显高于对照组的83.3%(P<0.05)。结论经筋刺法治疗周围性面瘫疗效确切,可改善瞬目反射、面部肌电图及动脉分支血流动力学相关指标,提升患者面神经功能和日常生活水平。

表情肌功能训练配合热敏灸治疗孕期周围性面瘫疗效观察

目的:观察表情肌功能训练配合热敏灸治疗孕期周围性面瘫的疗效。方法:30例按随机数字表法分为两组各15例。对照组用常规针刺,治疗组用表情肌功能训练配合热敏灸治疗。结果:治疗后治疗组TFGS评分、FDIP评分及No水平均高于对照组(P<0.05),治疗组FDIS评分、ET水平及H-B评分均低于对照组(P<0.05),治疗组总有效率高于对照组(P<0.05)。结论:表情肌功能训练配合热敏灸治疗孕期周围性面瘫疗效较好,且安全。

蝶腭神经节刺激术结合传统保守疗法治疗中重度周围性面瘫的临床研究

目的:探讨蝶腭神经节刺激术结合传统保守疗法对中重度周围性面瘫的临床疗效。方法:选取2020年5月—2022年3月上海市嘉定区中医医院收治的中重度周围性面瘫患者72例,随机分为两组。保守组接受激素、神经营养剂、康复及传统中医针灸治疗等;观察组在保守组基础上,予蝶颚神经节针刺疗法;两组均隔日治疗1次,治疗4周。治疗前后采用House-Brackmann(H-B)面神经功能分级量表、眼轮匝肌和口轮匝肌波幅、面部残疾指数(FDI)、简明生活质量评价量表(SF-36)比较两组患者症状改善情况以及检测免疫球蛋白水平并比较。结果:两组治疗后面神经功能分级、眼轮匝肌和口轮匝肌波幅、FDI、SF-36和免疫球蛋白水平均较治疗前显著改善(P<0.05),且观察组均显著优于保守组(P<0.05)。结论:蝶腭神经节刺激术结合传统保守疗法能有效改善中重度周围性面瘫患者面神经功能,提高生活质量。

以周围性面瘫为主要表现的吉兰-巴雷综合征变异型:附2例临床分析

该文报道了2例以周围性面瘫为主要表现的吉兰-巴雷综合征(GBS)变异型的患者。这2例患者均为以周围性面瘫起病,其中1例为双侧周围性面瘫,伴疼痛;另1例为左侧周围性面瘫合并头晕、思睡、食欲缺乏等。2例患者早期肌电图均未发现异常。1例存在脑脊液―蛋白细胞分离,另1例血清抗GQ1b抗体IgM(+)。诊断为GBS变异型。2例患者均给予静脉滴注人血免疫球蛋白,症状好转后出院。对以周围性面瘫起病的患者,需考虑是单纯的面神经炎还是以周围性面瘫起病的其他疾病,如GBS变异型等,以便正确诊治。

基于面肌超声指标评价针药结合治疗周围性面瘫所致面肌萎缩疗效

目的:基于面肌超声指标评价针药结合治疗周围性面瘫所致面肌萎缩的疗效。方法:选取146例周围性面瘫所致面肌萎缩患者,按照随机数字表法分为对照组和针药结合组各73例。研究过程中2组各剔除3例,最终均纳入70例。对照组采用针刺治疗,针药结合组在对照组基础上加用牵正散加减治疗。10 d为1个疗程,2组均治疗3个疗程。比较2组临床疗效、症状体征评分、面部神经功能评分、面肌超声指标及异常超声发生率,分析症状体征评分、面部神经功能评分与面肌超声指标之间的相关性。结果:治疗后,针药结合组总有效率95.71%,高于对照组84.29%,差异有统计学意义(P<0.05)。2组症状体征、面部神经功能评分均较治疗前降低,针药结合组症状体征、面部神经功能评分均低于对照组,差异均有统计学意义(P<0.05)。2组患侧额肌、降口角肌、降下唇肌厚度均较治疗前增加,针药结合组患侧额肌、降口角肌、降下唇肌厚度均大于对照组,差异均有统计学意义(P<0.05)。2组回声信号增强,肌纤维模糊、增粗发生率均较治疗前降低,针药结合组回声信号增强,肌纤维模糊、增粗发生率均低于对照组,差异均有统计学意义(P<0.05)。症状体征评分、面部神经功能评分与各项面肌超声指标均呈负相关,差异均有统计学意义(P<0.05)。结论:针药结合治疗周围性面瘫所致面肌萎缩疗效显著,能有效改善患者的临床症状和面部神经功能,面肌厚度、异常超声表现等指标对疗效有一定的评估价值。