Peripheral facial nerve palsy, also known as Bell’s palsy, refers to facial paralysis caused by lesions below the nucleus accumbens, often occurring on one side. The disease can develop in any season, but the incidence is higher in spring and autumn. It is called “hanging line wind” and “mouth seclusion” in Chinese medicine.
In Chinese medicine, it is thought to be caused by the lack of positive energy, the emptiness of the veins, the lack of solidity of the external guard, and the attack of wind and cold on the Yang Ming meridians and Shao Yang veins, resulting in the paralysis of the meridians, the stagnation of Qi and blood, and the loss of moistening of the facial muscles, which causes facial paralysis. Modern medicine believes that the cause of this disease is: (1) wind and cold attack causes spasm of blood vessels that nourish facial nerve, ischemia and edema, resulting in facial muscle paralysis. (2) Acute non-suppurative inflammation of the facial nerve in the mastoid foramen caused by viral infection, resulting in facial muscle paralysis. The pathological changes mainly cause non-purulent inflammation, edema, and varying degrees of degeneration of the myelin sheath or axon, especially in the stem-papillary foramen and the part of the facial nerve canal. Chen Rui, Department of Acupuncture, Affiliated Hospital of Guizhou Medical University
The onset of the disease is sudden, every time when sleeping or waking up or after blowing wind and cold face, incomplete eyelid closure, facial muscle paralysis, loss of forehead lines, enlarged eye fissure, shallow nasolabial fold, crooked corner of the mouth to the healthy side, salivation, inability to frown, frown forehead, cheek puff, show teeth and whistle, eyelid cannot be closed when eyes are closed, and eyeballs are strung up, commonly known as rabbit eye sign. When chewing, food is often retained between the cheeks on the diseased side. A small number of patients have pain behind the ipsilateral ear, inside the ear, under the ear, and on the face at the beginning of the disease. In severe cases, the patient may also experience a loss of taste in the anterior 2/3 of the tongue or auditory hypersensitivity.
When the lesion affects the tympanic nerve above the stapedial foramen, the anterior 2/3 of the tongue is impaired; when the lesion is above the stapedial branch, there is taste impairment and auditory hypersensitivity; when the geniculate ganglion is involved, there may be pain in the mastoid region and the patient may have herpes, severe pain and hyperalgesia in the external ear canal, which constitutes Hunt’s sign. When the great rock nerve passing through the geniculate ganglion is involved, there is reduced tear production on the affected side and impaired facial sweating.
Depending on the severity of the disease and whether the treatment is timely and appropriate, about 60-75% of patients start to improve in about 2-3 weeks and recover in 1-2 months, and most patients with partial degeneration on electrical stimulation of the facial nerve recover in about 3-6 months. In cases where complete degeneration does not fully recover in 4-6 months, contractures of the paralyzed muscles are commonly seen to form inversions.
Prognosis and treatment of this disease Note: There is a debate about the timing of acupuncture intervention, according to the staging of facial palsy: acute phase (1-7 days after onset), resting phase (7-20 days after onset) and recovery phase (20 days after onset) different interventions acupuncture and techniques, intensity, etc.
Early diagnosis, early treatment.
Acupuncture moderate, pay attention to manipulation.
The nature of facial nerve compression symptoms differ in prognosis. If the inflammation is below the mastoid foramen, it is simple facial neuritis, which is mild; if the inflammation is in the stapedius muscle or bulbar area, clinical loss of taste or auditory hypersensitivity in the anterior 2/3 of the tongue is moderate; in addition to the above symptoms, pain in the mastoid area and diminished sensation in the auricle and external auditory canal is severe. The milder the lesion, the better the prognosis.