Acupuncture treatment of peripheral facial nerve palsy

Peripheral Facial Nerve Palsy is an inflammatory neuropathy. Patients can have a viral prodrome. Although it is not universally accepted, some authors consider that idiopathic facial nerve palsy is a polyneuropathy, with slight findings referable to the trigeminal, glossopharyngeal, and vagus nerves, and the second cervical nerve in a significant part of patients. Overall, 45% of patients improved within 3 weeks, and 94% with incomplete paralysis eventually have complete recovery. Patients with partial paralysis and no denervation can recover in 4 to 6 weeks. With partial denervation, recovery is possible to be maximal at 12 weeks. If a patient does not recover fully within 3 months, complete remission is unlikely. According to the traditional chinese medicine the Peripheral Facial Nerve Palsy is derived from invasion of the channels and collaterals on Yangming and Shaoyang in facial region by exogenous pathogenic wind and cold, which leads to malnutrition of muscle regions of channels.

Case history

An 35-years-old female patient with sudden onset of peripheral facial nerve palsy of the right side was admitted in our department of traditional chinese medicine after de 4th day of starting the symptoms. In the evaluation, she complain  about a headache on frontal region irradiated to occipital area, persistent, intense, which start 5 days to 2 days before de onset. The movements of the affected side of the face were lost: voluntary, associated, and emotional. The right side was immobile and expressionless, the nasolabial fold was erased, and the mouth was drawn toward the left side. The eyebrow was elevated , The palpebral fissure was widened on the affected. When patients tried to shut their eyes, the lids of the right side remained open, and the eyeball rotates up. Tears tend to flow over the lower lid. The lips couldn’t be pursed; the cheek puffed out with respiration and she said that food tended to collect between the gums and cheek. She felt numbness on the affected side of the face. She suffered insomnia since the beginning of the palsy characterized by to wake up during the night 3 to 4 hours after starting sleeping and difficult on falling asleep again. On physical examination we found pale, purple and swollen tongue with tooth prints; rolling pulse. According to the bioenergetic diagnostic, the unbalance was considered as an obstruction of channel and collaterals due to an attack and invasion by exogenous pathogenic wind and damp of the channels and collaterals on Yangming and Shaoyang in facial region; deficiency of Spleen’s Qi and Stagnant Qi of Liver.

Treatment

The general strategy was to eliminate wind and damp of channels and collaterals of Yang Ming and Shaoyang; to promote the circulation of Qi and Xue, to tonify Spleen and Stomach. We harmonized the Qi of Liver and Gallbladder and tonified the Lung. Acupuncture was applied first in Chengqiang REN-24 and Renzhong DU-26, then it was tonified in the healthy side and we dispersed in the affected side on points: Dicang Neiting ST-44, Daying ST-5, Jiache ST-6, Xiaguan ST-7, Touwei ST-8, Quanliao SI-18, Yangbai GB-14, Yuyao (M-HN-6), Yingxiang L.I.-20, Jingming BL-1, Fengchi GB-20. Other points were Hegu L.I.-4, Tianfu LU-3, Sanyinjiao SP-6, Taibai SP-3, Zusanli ST-36. Laserpuncture were then applied in Quchi L.I.-11, Shenshu BL-23, Pishu BL-20, 1 min. 10 mW, red laser on each point. We applied the treatment daily, 12 sessions with needles and laser, and tuina massage daily since the session 13 to 17, and then the treatment end. She received also instruction for voluntary facial exercises for the muscles implicated.

Result

The same day of starting treatment, numbness on the affected side of the face disappeared and she was able to sleep 7 hours without awakening. The second day it was observed increase of tonus in the cheek; when patients tried to shut their eyes, the lids of the affected side start to close, and she start to sleep 8 hour daily without interruptions. At 3rd day the nasolabial fold starts to recover and when sleeping the family noticed she could close the eye of the affected side. The 7th day, she had recovered nasolabial fold, the occlusion eyes and the movements of the affected side. At 11th day, she blow without difficult; she had recovered the expression of the affected side and can sleep without problem.