Delayed onset peripheral facial nerve palsy after dental extraction: a case report and literature review.

Peripheral facial nerve palsy (PFP) is a rare occurrence after dental extraction. Early onset PFP after the procedure can be caused by trauma and/or local anesthesia, whereas delayed onset PFP has more speculative etiologies. The latter has a certain affiliation to Bell's palsy and is therefore primarily treated with corticosteroids, and long-term follow-up is often warranted. This article reports a unique case of a 30-year-old woman developing a delayed onset right-sided PFP after local intraoral anesthetic injection for molar extraction. Facial nerve injury was identified with signs of denervation and neuritis and the patient was treated with nonsteroidal anti-inflammatory drug, corticosteroids, vitamin B supplements, and mime therapy. After 9 months, the patient showed an improvement of the facial muscle activity and went from a grade IV to a grade III on the House-Brackmann grading scale.

Electroacupuncture combined with Qianzhengsan decoction for the treatment of peripheral facial paralysis: A retrospective study.

This study retrospectively explored the effectiveness of electroacupuncture (EA) combined with Qianzhengsan decoction (QZSD) for the treatment of peripheral facial paralysis (PFP). This retrospective study included patients with PFP admitted to a single hospital between July 2018 and June 2020. Ninety patients were included and divided into treatment (n = 45) and control (n = 45) groups. All the patients in both groups received oral prednisone tablets and mecobalamin. In addition, patients in the treatment group received EA and QZSD. The outcomes were the overall response rate, facial nerve function, facial nerve electromyography, and adverse events. All outcome data were analyzed before and after treatment. Patients in the treatment group achieved better outcomes than those in the control group in improving overall response rate (P = .04), facial nerve function (P < .01), and facial nerve electromyography (P < .01). Patients in both groups reported adverse events. The results of this study showed that patients with PFP and QZSD received better outcomes than those who did not. Further studies are required to confirm these results.

[Professor SHENG Can-ruo's experience in treatment of peripheral facial paralysis with combined therapy of acupuncture-moxibustion and herbal medicine].

This paper introduces the specific clinical experience of professor SHENG Can-ruo in treatment of peripheral facial paralysis with the combination of acupuncture-moxibustion and herbal medicine. Professor SHENG Can-ruo advocates "acupuncture-moxibustion for the external and herbal decoction for the internal", inventes "three facial points" and "jianei point" and experienced in "pair points" and "pair herbs". Professor SHENG rationally applies penetrating needling technique, mutually uses acupuncture-moxibustion and herbal medicine and determines the treatment in stages so that the remarkably clinical effect has been achieved on peripheral facial paralysis.

Professor / 中国针灸

This paper introduces the specific clinical experience of professor

Neural mobilization in Bell's palsy: A case report.

Background: Bell's palsy (BP) is a sudden onset of signs and symptoms of facial nerve dysfunction. The treatment of choice is corticosteroids and antiviral drugs. These drugs are risky for individuals with pre-existing conditions such as diabetes, high blood pressure, and digestive disturbances. Therefore, a beneficial complementary therapy would add to the success of treatment.Clinical Presentation: A 42-year-old male presented with left side facial paralysis and asymmetry. The patient received neural mobilization along with routine physical therapy for 1 hour, 5 days a week, for 3 weeks. A follow-up was scheduled at the 8th week.Clinical Relevance: Neural mobilization technique of the facial nerve is a novel and safe addition to the conservative treatment of BP.

The effects of lipoic acid and methylprednisolone on nerve healing in rats with facial paralysis.

OBJECTIVE: To investigate the effects of lipoic acid and methylprednisolone on nerve healing in rats with traumatic facial paralysis. MATERIALS AND METHODS: The rats were randomly divided into four groups, with six rats in the control group and eight each in the remaining three groups. The buccal branch of the facial nerve in all groups except the control group was traumatized by a vascular clamp for 40 minutes. Group 1 was given lipoic acid (LA), Group 2 was given methylprednisolone (MP), and Group 3 was given lipoic acid and methylprednisolone (LA + MP) for one week. Nerve stimulus thresholds were measured before trauma, after trauma and at the end of the one week treatment period. RESULTS: When the groups were compared with each other, post-treatment threshold levels of LA + MP were significantly lower than LA. Although post-treatment threshold levels of LA and MP were still higher than the control group, there was no significant difference between LA + MP and control values (p > .05). CONCLUSION: Lipoic acid has a positive effect on nerve healing and can enhance the effect of methylprednisolone treatment. It is a good alternative in cases where methylprednisolone cannot be used.

Yamamoto New Scalp Acupuncture, Applied Kinesiology, and Breathing Exercises for Facial Paralysis in a Young Boy Caused by Lyme Disease-A Case Report.

The case study reports on the effect of pharmacological, complementary, and alternative medicine including YNSA, Applied Kinesiology, and respiratory exercises in a 9-year-old boy with facial paralysis. The boy suffered from borreliosis and one-sided facial paralysis that occurred 3.5 weeks after being bitten by a tick and persisted despite 4 weeks of medication with antibiotics. In the first treatment, muscle function as assessed by the coachman׳s test was normalized, and improvement in the facial paralysis was observed. Within 8 additional treatments over a period of 2 months, the boy showed complete recovery. The case shows a multimodal approach to facial paralysis integrating pharmacological treatment and CAM including YNSA, Applied Kinesiology, and breathing exercises.

[Professor HE Tianyou's clinical experience of acupuncture and medicine on intractable facial paralysis].

Professor HE Tianyou's unique understanding and treatment characteristics for intractahle facial paralysis are introduced. In clinical practice professor HE highly values acupoint selection and manipulation application, and integrates Chinese and western medicine to flexibly choose acupoints and formulate prescriptions according to syndrome differentiation and location differentiation, besides, he creates several specialized manipulation methods including "tug-of war opposite acupuncture method" and "tractive flash cupping". Based on strengthening body and dredging collaterals. more attention is given on stimulation to local paralyzed facial nerves; meanwhile acupuncture and medication are combined to improve clinical efficacy. During the treatment, the important role of psychological counseling on patient's anxiety is emphasized, and comprehensive treatment is given physically and psychologically in order to achieve the purpose of total rehabilitation.

Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis.

OBJECTIVES/HYPOTHESIS: The present study was conducted to develop a new method for maintaining the effect of botulinum toxin treatment for facial sequelae. We used a combination strategy including the administration of botulinum toxin three times at 6-8-month intervals followed by daily newly developed half-mirror biofeedback rehabilitation for about 2 years from the first injection. STUDY DESIGN: This was a prospective study. METHODS: Seventeen patients with unilateral facial palsy for >1 year were included in the study. The amount injected per site varied from 1.5 to 3 U. The purpose of the first injection was to reduce the most inconvenient facial problem such as facial synkinesis or hyperkinetic movement at the points of the periocular area and the zygomaticus major and minor muscles with an average dosage of 17.4 ± 13.9 U. The second injection was to enhance facial symmetry at prominent hypertrophic areas on the contralateral side with 36.5 ± 15.4 U, and the third injection was to add cosmetic configuration at the points of deep furrows and creases caused by facial muscular hyperkinesis or atrophy with 15.6 ± 8.4 U. RESULT: After three injections of botulinum toxin A and 2 years of half-mirror biofeedback exercises, all patients showed marked relief of facial synkinesis and facial asymmetry. Before treatment, the mean ± standard deviation (SD) Sunnybrook (SB) score was 36.8 ± 8.76. After the first injection, the score increased by 11.4. After the second injection, the score increased by 14.6; it further increased by 15.6 after the third injection. CONCLUSION: This facial rehabilitation strategy, consisting of three injections of botulinum toxin and half-mirror biofeedback exercises, proceeds over the course of 2 years and offers a long-lasting cure for facial synkinesis and facial symmetry as well as improved facial aesthetics.

Viabilidade do uso do óleo essencial da Alpinia zerumbet, Zingiberaceae, na otimização do tratamento fisioterapêutico em paralisia cerebral espástica / Feasibility of using essential oil of Alpinia zerumbet, Zingiberaceae, the optimization of physical therapy in spastic cerebral palsy

Objetivo: O objetivo deste estudo foi avaliar a viabilidade do óleo essencial da Alpinia zerumbet associado ao tratamento fisioterapêutico da paralisia cerebral. Métodos: O estudo foi prospectivo, analítico e clínico do tipo II, aleatório por grupos em períodos específicos. A amostra, N = 24, de crianças com paralisia cerebral foi dividida em quatro grupos: dois grupos de cinesioterapia tratado com óleo essencial e seu controle, por via dérmica, na dose de 0,5 kg ml/10 kg, e dois grupos de cinesioterapia, tratado com óleo essencial e seu controle, por via inalatória, na dose 0,05 ml/10 kg/5 ml de soro fisiológico por 15 minutos. A espasticidade muscular e as atividades funcionais estáticas e dinâmicas foram mensuradas pelo protocolo de Durigon (2004). Os testes t-Student e ANOVA foram utilizados para a significância de 95%. Resultados: Os grupos tratados com óleo essencial apresentaram resultados significativos na avaliação do tônus muscular e na função estática e dinâmica. Conclusão: O óleo essencial associado à cinesioterapia modula o tônus muscular, possibilitando ganho funcional. As crianças tratadas de forma dermal apresentaram melhor resultado em relação às que inalaram o óleo essencial.

Objective: The objective of this study was to evaluate the feasibility of the essential oil of Alpinia zerumbet associated with physical therapy for cerebral palsy. Methods: The study was a prospective, clinical analytical type II, random by groups in specific periods. The sample, N = 24, were children with cerebral palsy was divided into four groups: groups of exercise treated with essential oil and its control and dermal administration of 0.5 kg ml/10 kg and two groups of kinesiotherapy treated with essential oil and its control by inhalation at a dose of 0.05 ml/10 kg/5 ml saline for 15 minutes. Muscle spasticity and the static and dynamic functional activities were measured by protocol Durigon (2004). The Student t-tests and ANOVA were used for the 95% significance. Results: The groups treated with essential oil showed significant results in the assessment of muscle tone and function static and dynamic. Conclusion: The essential oil associated with the kinesiotherapy modulates the tone making it functional gain. Children treated in such a way that showed best results for dermal which inhaled the essential oil.

Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: an off label pilot-study.

BACKGROUND: Animal tests, retro- and prospective clinical trials in neurosurgical departments have shown a beneficial effect of nimodipine on the preservation and recovery of facial and acoustic nerve function following vestibular schwannoma surgery. Encouraged by these positive results a pilot-study of nimodipine treatment in patients with a peripheral facial nerve (FN) paresis following maxillofacial surgery was performed. The rate and time of FN recovery were analysed and compared with the results in the literature. METHODS: Thirteen patients (n = 13) suffering from a moderate (1/13) up to a severe (12/13) peripheral FN paresis after maxillofacial surgery were treated with orally administered nimodipine. The anatomical main course of the FN was preserved in all patients with a 2nd to 3rd degree of Sunderland-injury (Sunderland, 1951). After no evidence of a spontaneous regeneration had shown, oral medication with nimodipine was started as an "off-label" use. RESULTS: An improvement of the FN function correlated to the start of the vasoactive medication and as a consequence a recovery of the FN function up to House-Brackmann (HB) grade I°-II° was observed in all the patients within a period of 2 months after the beginning of treatment (p = 0.00027). CONCLUSIONS: The clinical observations in these patients suggest a positive effect of nimodipine on the acceleration of peripheral FN regeneration after surgically caused trauma. The results of this pilot-study are very promising. A prospective study with a larger number of patients is planned to approve the beneficial effect of nimodipine on the peripheral FN in maxillofacial or otorhinolaryngological surgery.

Mirror biofeedback rehabilitation after administration of single-dose botulinum toxin for treatment of facial synkinesis.

OBJECTIVE: The efficacy of facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin on facial synkinesis was examined in patients with chronic facial palsy. STUDY DESIGN: Prospective clinical study. SETTING: University hospital. SUBJECTS AND METHODS: The present study includes 8 patients with Bell palsy and 5 with herpes zoster oticus showing facial synkinesis. A single dose of botulinum A toxin was used as the initial process of facial rehabilitation. Patients then continued a daily facial biofeedback rehabilitation with a mirror at home. They were instructed to keep their eyes symmetrically open using a mirror during mouth movements. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry of eye opening width during mouth movements (% eye opening). RESULTS: After administration of a single dose of botulinum A toxin, temporary relief of facial synkinesis was observed in all patients. Patients were then instructed to continue the facial biofeedback rehabilitation with a mirror for 10 months. The mean values of the percent of eye opening during 3 designated mouth movements that included lip pursing /u:/, teeth baring /i:/, and cheek puffing /pu:/ increased significantly after 10 months when the effects of botulinum A toxin had completely disappeared. CONCLUSION: These findings demonstrate that facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin is a long-lasting treatment of established facial synkinesis in patients with chronic facial palsy.

[Clinical observation on the principle of "single usage of acupoints of Shaoyang meridian" for treatment of facial paralysis in acute stage].

OBJECTIVE: To compare different therapeutic effects between single usage of acupoints of Shaoyang meridian and the routine ones for treatment of Bell palsy in acute stage. METHODS: One hundred and twenty cases with Bell palsy during the first three days were random divided into an observation group and a control group, 60 cases in each group. In observation group, acupoints of Shaoyang meridians were used from the 3rd day till the 14th day, Fengchi (GB 20), Yifeng (TE 17), Wangu (GB 12) at the affected side etc. were selected, after the 15th day, the routine acupoints were applied, Hegu (LI 4) on both sides, Fengchi (GB 20), Quchi (LI 11), Yangbai (GB 14) at the affected side etc. were selected; the control group were treated with the same acupoints as the routine ones in observation group since the 3rd day. And both two groups were treated with oral administration of Prednisone. House-Brackmann (H-B) functional grading of facial nerve on the 3rd day with the one of the 60th day as well as electroneurography (ENoG) on the 3rd day with the one of the 14th day were compared respectively. RESULTS: The H-B grading improvement and cured rate were 95.0% (57/60) in observation group, which were suprior to 83.3% (50/60) in control group; the cured time in observation group was (34.21 +/- 8.026) days, significantly shorter than (42.78 +/- 9.029) days in control group (P < 0.05). CONCLUSION: On the basis of oral administration of Prednisone, single usage of acupoints of Shaoyang meridian in acute stage can make great improvement for recovery of Bell palsy, better than routine point selection.

[Comparison of therapeutic effects of peripheral facial paralysis in acute stage by different interventions].

OBJECTIVE: To compare the therapeutic effects of peripheral facial paralysis in acute stage by different interventions and explore the better treatments of peripheral facial paralysis. METHODS: One hundred and thirty one cases of Bell's facial paralysis were randomly divided into three groups. In acupuncture group (44 cases), Dicang (ST 4), Jiache (ST 6), Hegu (LI 4), Yangbai (GB 14) and Taiyang (EX-HN 5), etc. were applied; in electroacupuncture group (45 cases), the selection of acupoints and needling method were same as those in acupuncture group, and the electroacupuncture therapy was applied on Dicang (ST 4), Xiaguan (ST 7), Yangbai (GB 14) and Taiyang (EX-HN 5) in acute stage; in medication and acupuncture group (42 cases), Prednisone and Acyclovir were taken by oral administration, Vitamin B1 and Vitamin B12, were applied by intramuscular injection in acute stage, and acupuncture was applied by the way which was same as that in acupuncture group during quiescent and recovery stages. The curative effects were evaluated by House-Brackmann Grading Scale, and the failed rates were observed by follow-up after one and three months. RESULTS: The cured and markedly effective rates were 79.6% (35/44), 93.4% (42/45) and 78.6% (33/42) respectively in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.05). The cured rates above tympanichord were 54.2% (13/24), 85.2% (23/27) and 48.0% (12/25) in acupuncture group, electroacupuncture group and medication and acupuncture group, and the result in electroacupuncture group was superior to those in acupuncture group and medication and acupuncture group (P < 0.01). There was no significant differences of cured rates below tympanichord among three groups (P > 0.05); and the failed rate in electroacupuncture group was much lower than those in acupuncture group and medication and acupuncture group by follow-up after one and three months (all P < 0.01). CONCLUSION: The peripheral facial paralysis is effectively treated by electroacupuncture in acute stage, and it suggests that electroacupuncture should be applied early during the acupuncture treatment of peripheral facial paralysis.

[Simultaneous injection of lidocaine improves predictability of effect of botulinum toxin]. / Simultane Injektion mit Lidocain verbessert die Vorhersehbarkeit des Effekts von Botulinumtoxin.

Injection of botulinum toxin A is a common procedure in Otorhinolaryngology, Ophtalmology and Neurolgy. Recently botulinum toxin treatment has been described to improve woundhealing after facial injuries. The lack of immediate predictibility of the ensuing paralytic effect is one of the daily challenges of botulinum toxin injections. In the present report we describe the simultaneous injection of botulinum toxin and lidocaine with the purpose to gain immediate feed back of the treatment effect. Furthermore we recommend the addition of adrenalin to reduce possible systemical toxin circulation.

[St. John's Wort, corticosteroids, cocaine, alcohol ... and a first manic episode]. / Millepertuis, corticoïdes, cocaïne, alcool ... et un premier épisode maniaque. Femme, 36 ans, artiste.

We describe an alcohol and cocaine abusing female patient who developed a first manic episode in the context of a corticosteroid prescription. The differential diagnoses are discussed on the basis of the available literature on secondary manias.

[A case of Lyme disease with the triad of neurologic manifestations (meningitis, radiculoneuritis, facial nerve palsy) and dermatitis of the nail roots].

A 23-year-old man experienced dysesthesia of the distal parts of four limbs and spilling of drinking water from the right corner of his mouth. He also experienced low grade fever, headache, and nausea. Neurological examination showed weakness of the right frontal, orbicularis oculi and orbicularis oris muscles, atrophy and weakness of the interosseous muscles in both upper limbs and dysesthesia in the distal parts of four limbs. Laségue's sign was also positive on the left side. Examination of CSF showed lymphocytic pleocytosis and an increase of total protein. Serum antibody against Borrelia garinii was positive as determined by ELISA. The patient was diagnosed as a case of Lyme disease. His symptoms were not alleviated by administration of ceftriaxone (2 g/day) for 15 days, and dermatitis of nail roots appeared. Following administration of penicillin G at a high dose (12 million units/day) for 20 days, both neurologic symptoms and dermatitis were alleviated. Since B. garinii was reported to move preferentially toward the sites of low temperature, dermatitis of nail roots may be one of the characteristic features of Lyme disease caused by B. garinii.