Principles and methods of facial palsy treatment

  Bell’s palsy (facial neuritis) is a peripheral facial nerve palsy caused by acute septic facial neuritis in the foramen ovale, the exact cause of which is unknown. It is possible that acute viral infection and edema of the facial nerve in the foramen ovale may cause facial paralysis due to compression of the facial nerve or local blood circulation disorders. The pathology of Bell’s palsy is mainly edema of the facial nerve, swelling and loss of myelin sheath, and axonal degeneration of varying degrees in the late stage, especially in the stem mammary foramen and the part of the facial nerve canal. Facial nerve palsy belongs to the category of “facial palsy” and “mouth and eyes” in Chinese medicine. The facial nerve palsy belongs to the category of “facial palsy” and “mouth-eye obliquity”.  Modern medical treatment of Bell’s palsy mainly uses drugs and surgery, such as steroid corticosteroid therapy (prednisone, etc.), vitamin therapy (VitB1, VitB12, methylcobalamin tablets, etc.), vasodilators (dibazol, etc.), neurotrophic drugs (nerve growth factor, gangliosides), physical therapy, functional exercise and surgery, in the acute phase (within 7 to 10 days of onset) treatment Since adrenocorticotropic hormone has the function of inhibiting inflammation and reducing local edema of the facial nerve, hormone therapy has almost become a widely used method in the acute phase of Bell’s palsy. Hormone therapy should be used in sufficient quantity and for a short period of time (about 2 weeks). The results of foreign studies have shown that the early use of prednisone (especially in the acute phase) is very beneficial, and the clinical recovery is better than the use of antiviral acyclovir (ACV) alone, which can reduce the chance of more damage to the facial nerve and the sequelae of facial muscle spasm, and patients who cannot use prednisone can consider using the antiviral acyclovir.  It was found that more than 93% of patients with complete Bell’s facial palsy treated with early application of acupuncture and steroids (prednisone, etc.) recovered, while only 85% of patients treated with steroids alone (prednisone, etc.) recovered, and only 68% of patients treated with vitamins and vasodilators without steroids were cured. In addition, the efficacy of surgery is still difficult to determine and should be tried only in severe cases. It can be seen that the treatment method (combination of acupuncture and medication) is very important within 7-10 days of the onset of the disease, and the basic recovery can be achieved within a month.  According to clinical observation, facial paralysis can be divided into 5 stages: Stage I is the acute stage, within 7-10 days; Stage II is the recovery stage, 10 days to 1 month; Stage III is the observation stage, 2-3 months; Stage IV is the refractory stage, 4-6 months; Stage V is the sequelae stage, more than 6 months. The treatment principle of combining Chinese and Western medicine is mainly for patients in stage I and II. It is also believed that the earlier acupuncture treatment is given to patients with facial palsy, the better. Meanwhile, patients with stage I and II can take oral hormones, dibazol, vitamin B and other drugs, which can effectively improve facial blood circulation, promote early decreasing of local edema and inflammation, improve local nutrient metabolism, and accelerate the recovery of facial muscle function.  In conclusion, conventional western medical treatment combined with acupuncture is used in the acute phase, while acupuncture treatment is the main treatment in the recovery phase, together with nerve-nourishing western medicine and traditional Chinese medicine. During the acute period, recovery period and observation period, electro-acupuncture should not be used; during the post-acute period, the amount of stimulation of facial acupuncture points can be slightly enhanced by deep or penetrating acupuncture, and electro-acupuncture can also be used, but the amount of stimulation should not be too large, otherwise it will easily cause facial muscle spasm. Finally, it must be remembered that the functional training of the face (insist on doing 10-15 minutes of facial exercises in front of the mirror several times a day, such as raising the eyebrows, raising the forehead, closing the eyes with force, showing the teeth, lifting the corners of the mouth, puffing the cheeks, etc.) should be started as early as possible.