Surgical interventions for the early management of Bell's palsy

Acupuncture treatment of a pregnant patient with Bell's palsy in the third trimester: Case report

At present, the optimal treatment for Bell's palsy remains controversial, and the combination of corticosteroids and antiviral medication is usually recommended in the early stage. However, treatment is often delayed because the effects of these drugs on pregnant women and fetuses are still unclear. As a safe and effective complementary alternative therapy, acupuncture can alleviate Bell's palsy symptoms and improve the quality of life of the patient. Herein, we report the clinical presentation of a 27-year-old woman with Bell's palsy who was 26 weeks pregnant at the time of diagnosis. After five courses of treatment, the patient made a complete recovery.

Selective Neural Electrical Stimulation of an Injured Facial Nerve Using Chronically Implanted Dual Cuff Electrodes

Facial nerve (FN) injury can lead to debilitating and permanent facial paresis/paralysis (FP), where facial muscles progressively lose tone, atrophy, and ultimately reduce to scar tissue. Despite considerable efforts in the recent decades, therapies for FP still possess high failure rates and provide inadequate recovery of muscle function. In this pilot study, we used a feline model to demonstrate the potential for chronically implanted multichannel dual-cuff electrodes (MCE) to selectively stimulate injured facial nerves at low current intensities to avoid stimulus-induced neural injury. Selective facial muscle activation was achieved over six months after FN injury and MCE implantation in two domestic shorthaired cats (Felis catus). Through utilization of bipolar stimulation, specific muscles were activated at significantly lower electrical currents than was achievable with single channel stimulation. Moreover, interval increases in subthreshold current intensities using bipolar stimulation enabled a graded EMG voltage response while maintaining muscle selectivity. Histological examination of neural tissue at implant sites showed no appreciable signs of stimulation-induced nerve injury. Thus, by selectively activating facial musculature six months following initial FN injury and MCE implantation, we demonstrated the potential for our neural stimulator system to be safely and effectively applied to the chronic setting, with implications for FP treatment.

Research on the application of myofascial induction therapy in the rehabilitation of patients with acute facial palsy: A nonrandomized controlled trial

BACKGROUND

In the healthy body, the fascial system maintains elasticity and coordination of movements. If these functions are destroyed, facial paraly appears. Myofascial induction therapy (MIT), a manual physical therapy method that focuses on restoring altered fascial tissue, is prevalently and widely used in clinical treatment.

OBJECTIVE

The study aimed to observe the application of MIT in the rehabilitation of patients with acute facial palsy.

METHODS

Sixty-eight patients with acute facial palsy were divided into control group and manual treatment group. The control group received drug treatments, such as prednisone, methylcobalamin, and vitamin B1, and instrumental physical therapy, such as semiconductor laser, shortwave therapy, and facial muscle training. In addition to these treatments, the manual treatment group received MIT. Both groups were treated for 4 weeks. The patients were assessed using the following methods: the House-Brackmann facial nerve function evaluation, Sunnybrook facial grading system, facial nerve electrophysiological examination compound muscle action potential (CMAP) amplitude, and blink reflex (BR) R1 latency.

RESULTS

House-Brackmann and Sunnybrook scores and CMAP amplitude and BRR1 latencies were significantly different between the two groups (p <  0.05). Furthermore, the manual treatment group showed greater improvement than the control group (p <  0.05).

CONCLUSIONS

Treatment with MIT promoted better recovery of acute facial palsy and thus may be considered a valid rehabilitation intervention that is worthy of clinical application.

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

Background

Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy.

Methods

Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment.

Discussion

The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals.

Trial registration

CHICTR ChiCTR2000038472. Registered on 23 September 2020

Computed tomographic features of the proximal petrous facial nerve canal in recurrent Bell's palsy

OBJECTIVES

The primary objective was to determine whether the narrowest dimensions of the labyrinthine facial nerve (LFN) canal on the symptomatic side in patients with unilateral recurrent Bell's palsy (BP) differ from those on the contralateral side or in asymptomatic, age- and gender-matched controls on computed tomography (CT). The secondary objectives were to assess the extent of bony covering at the geniculate ganglion and to record inter-observer reliability of the CT measurements.

METHODS

The dimensions of the LFN canal at its narrowest point perpendicular to the long axis and the extent of bony covering at the geniculate ganglion were assessed by two radiologists. Statistical analysis was performed using the Wilcoxon signed-rank and Mann-Whitney U tests (LFN canal dimensions) and the Chi-squared test (bony covering at the geniculate ganglion). Inter-observer reliability was evaluated using Intra-Class Correlation (ICC) and Cohen's kappa.

RESULTS

The study included 21 patients with unilateral recurrent BP and 21 asymptomatic controls. There was no significant difference in the narrowest dimensions of the ipsilateral LFN canal when compared to the contralateral side or controls (P = .43-.94). Similarly, there was no significant difference in the extent of bony covering at the geniculate ganglion when compared to either group (P = .19-.8). Good inter-observer reliability was observed for LFN measurements (ICC = 0.75-0.88) but not for the bony covering at the geniculate ganglion (Cohen's kappa = 0.53).

CONCLUSION

The narrowest dimensions of the LFN canal and the extent of bony covering at the geniculate ganglion do not differ in unilateral recurrent BP, casting doubt over their etiological significance.

LEVEL OF EVIDENCE

Level IV.