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.

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.

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.

Effect of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis:A systematic review and meta-analysis

Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Methods: PubMed(1979-2017), the Chinese National Knowledge Infrastructure database(CNKI, 1979-2017), Wanfang databases(1990-2017), and the Chongqing VIP full-text periodical database(VIP, 1989-2017) were searched by computer. Randomized controlled trials of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis were collected. The clinical trials that met the inclusion criteria were selected for quality assessment using the Cochrane 5.0 Handbook for systematic evaluation.RevMan5.3 was used for statistical analysis.Results: A total of 23 articles with 1756 patients met the inclusion criteria.(1) The meta-analysis of 11 articles showed that the total effective rate of warm needling therapy for peripheral facial paralysis was higher than that of acupuncture [RR = 1.18, 95% Cl(1.11,1.25), P< 0.00001].(2) The meta-analysis of 7 articles showed that the total effective rate of warm needling therapy combined with electroacupuncture in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with electroacupuncture [RR= 1.15, 95% Cl(1.09, 1.21), P< 0.00001].(3) The meta-analysis of 5 articles showed that the total effective rate of warm needling therapy combined with other therapies in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with other therapies [RR= 1.08,95% Cl(1.03, 1.14), P=0.002].(4) The meta-analysis of 5 articles showed that warm needling therapy could improve the House-Brackmann(H-B) scores of patients with peripheral facial paralysis more than acupuncture [mean difference(MD)=-2.85, 95% Cl(-5.08,-0.62), Z = 2.51, P = 0.01], indicating that warm needling therapy provides superior improvement in the function of facial nerve innervation in the patients. No adverse events were reported in the included studies. The methodological quality of the included studies was generally low.Conclusion: The results of this meta-analysis showed that warm needling therapy is superior to acupuncture in treating peripheral facial paralysis, providing a therapeutic option for the treatment of peripheral facial paralysis. However, due to the small sample size and the low quality of the included studies, the above conclusion still needs to be validated with high-quality, large-scale, randomized, blinded controlled trials.

Thirty-three cases of refractory peripheral facial paralysis treated with the combination of warming-needle moxibustion and stuck-needle-pulling therapy

Objective:To observe the clinical therapeutic effect on refractory peripheral facial paralysis treated with the combination of warming-needle moxibustion and stuck-needle-pulling therapy.Methods:A total of 33 patients with refractory peripheral facial paralysis were treated with the combination of warming-needle moxibustion and stuck-needle-pulling technique.The treatment was given once daily and there were 2 days at interval after consecutive 5 treatments.A total of 10 treatments made one course and consecutive 2 courses of treatment were required.Before and after treatment,HouseBrackmann(H-B)facial nerve grading scale score was adopted to evaluate the degree of facial paralysis in the patients and the clinical effect was assessed.Results:After treatment,the mean H-B score was higher than that before treatment in the patients,indicating a statistical significance(P<0.05).After treatment,of 33 cases,12 cases were cured,9 cases effective remarkably,8 cases effective and 4 cases no effect.The total effective rate was 87.88%.Conclusion:The combination treatment of warming-needle moxibustion and stuck-needle-pulling technique achieves a definite effect on refractory peripheral facial paralysis.

Clinical observation of epiphora as sequela of peripheral facial paralysis treated with pricking technique of fire needling therapy at Chengqi(承泣ST1)

Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conventional acupoints.Methods:From September 2018 through to October 2018,64 cases of epiphora as sequela of peripheral facial paralysis were collected from the Department of Acupuncture-Moxibustion in Suzhou TCM Hospital.According to random number table,they were divided into an observation group and a control group,32 cases in each one.In the observation group,pricking technique of fire needling therapy was used at ST1,once every two days.In the control group,acupuncture with filiform needle was applied to Jingming(睛明BL1),Taiyang(太阳EX-HN5),Tongziliao(瞳子髎GB1),Sibai(四白ST2)and Quanliao(颧髎SI18)on the affected side as well as Hegu(合谷LI4)on the contralateral side,once per day.The 10-day treatment was as one 1 course and the consecutive 3 courses of treatment were required in either of the groups.Before and after treatment,Munk grade,clinical effective rate and the number of treatments were observed in the evaluation of therapeutic effect.Results:After treatment,Munk grade was improved in the patients of the two groups(both P<0.05).The improvement range in the observation group was larger than that of the control group(P<0.05).The treatment in either group achieved the obviously therapeutic effect on epiphora as sequela of peripheral facial paralysis.The effective rate in the observation group was 90.32%,higher than 61.29%in the control group(P<0.05).The mean number of treatments of the curative case were 5.11 in the observation group and were 13.73 in the control group,indicating the statistical significance in difference(P<0.05).Conclusion:Pricking technique of fire needling therapy at ST1 achieves the better effect on epiphora as sequela of peripheral facial paralysis as compared with acupuncture at conventional acupoints.

44 Cases of Peripheral Facial Paralysis Treated by the SXDZ-100 Nerve and Muscle Stimulator

Objective: To observe the clinical effects of the Hua Tuo Manual Acupuncture Therapeutic Stimulator for peripheral facial paralysis. Methods: 87 patients with peripheral facial paralysis were divided randomly into the SXDZ-100 Nerve and Muscle Stimulator treatment group (44 cases) and the G6805 Electric Stimulator control group (43 cases). The acupoints selected for both the two groups were local points as well as distal points as Hegu (LI 4), Waiguan (TE 5), Sanyinjiao (SP 6), Taichong (LR 3). Effectiveness was compared between the two groups. Results: Both groups had a total effective rate of 100%. But the cure rate was 90.9% in the treatment group, and 73.0% in the control group, indicating a significant difference (P<0.05). No side effects were found in either of the two groups. Conclusion: The SXDZ-100 stimulator is more effective than the G6805 electroacupuncture stimulator for treatment of peripheral facial paralysis.

Acupuncture for facial nucleus paralysis

Case of acupuncture for facial nucleus paralysis was reported. Compared with peripheral facial paralysis, facial nucleus paralysis is more complex with a high-level and high-degree injury, leading to a low cured rate in clinic. This case was cured successfully, which might be related to less bleeding amount from patients＇ lesion and more complete absorption of blood stasis, as well as accuracy of clinical syndrome differentiation, positioning and appropriateness of treatment method and acupoint selection of acupuncture in the mid to late stage.

Therapeutic Effect Observations on Individualized Treatment of Peripheral Facial Palsy

Objective： To investigate the curative effect of individualized treatment on peripheral facial paralysis. Methods： A treatment group of 121 patients was treated with acupuncture under an individualized plan based on the condition of disease. For a control study, 118 patients were treated with conventional acupuncture. The courses of treatment and the curative effects were compared. Results： The cure and marked efficacy rate was 90.9% in the treatment group and 69.5% in the control group. There was a significant difference （P〈0.01）. There was also a significant difference in the cure and marked efficacy rate in each courses of treatment between the two groups （P〈0.01）. Conclusion： Individualized acupuncture treatment is better in the effect and shorter in the courses than conventional acupuncture treatment for peripheral facial paralysis.