Facial myoclonus is a common clinical condition, but a difficult one to treat. Facial myoclonus is a paroxysmal, irregular group of muscle contractions on one side of the face, also known as facial twitching disorder. The cause is still unclear (1), and there is no better treatment method. Our department treats facial muscle spasm according to the anatomy of facial nerve, combined with the acupuncture medical theory of cutting off part of facial nerve endings. Through several years of clinical case verification, the treatment of facial muscle spasm by cutting off part of the facial nerve endings with acupuncture is satisfactory. It is reported as follows.
1.Data and methods
1.1 General information
From 2004 to 2009, our department treated 56 outpatients by cutting off part of the facial nerve endings with acupuncture. Among them, 12 cases were male and 44 cases were female, aged from 43 to 61 years old, and the duration of the disease ranged from 1, 5 to 15a. All of them were involuntary spastic twitches of the facial muscles.
1, 2 Acupuncture treatment
(1) Position: supine position with a thin pillow on the head and neck and the patient’s face facing upward.
(2) Spotting: 3 to 5 needle-knife treatment spots can be set on the affected side of the brow arch. (depending on the severity of the spasm in the arch of the eyebrow)
(3) The lateral end of the eye fissure can be continued from the medial side of the eye fissure to the lateral side of the bone to set 2 to 3 points for treatment.
(4) 5 to 15 points can be fixed along the highest point of the zygomatic bone surface. (Depending on the severity of the spasm, two rows of treatment points can be set at the upper and lower edges of the zygomatic bone in heavy cases)
(5) For the mandible, the number of treatment points can be set according to the severity of the spasm, but the mandibular artery must be avoided.
Each of the above needle knife treatment points are set at the bone convexity, not at the depression of the bone.
1, 3 sterilization and anesthesia skin routine sterilization, wearing sterile gloves, laying sterile towel, local anesthesia after performing needle knife relaxation, each needle knife treatment point anesthesia to the bone surface, slightly withdrawn to the periosteum outside, back aspiration without returning blood, in a fan shape to be anesthetized, to achieve adequate anesthesia, so that the needle knife operation to ensure that the patient is painless [1].
1.4 Needle knife operation into the arch of the eyebrow, the knife line is parallel to the skin line, in line with the arch of the eyebrow, and the knife body is perpendicular to the skin surface. Rapidly pierce the skin and subcutaneous tissue straight to the periosteal surface. Allow the blade to float naturally and hold it in this position. Tilt the knife handle toward the caudal end, a few parallel to the skin surface, and make a fan shovel peel along the periosteal surface toward the cephalic end after 3 to 5 strokes to stop bleeding with compression and ensure that the wound does not bleed [1].
At the lateral end of the eye fissure, spatula debridement is performed at the center of the fixation point, above, outside, and below the outside. The knife line is parallel to the skin line, i.e., parallel to the frontal plane, and the body of the knife is perpendicular to the skin surface, and is quickly stabbed subcutaneously to the periosteal surface. The blade is allowed to float naturally and is fixed in this position. The blade is rotated 90° to tilt the handle of the knife in the direction of the central axis, a few parallel to the skin surface, and a fan-shaped spatula peel is made posteriorly along the periosteal surface for 3 to 5 strokes before pressure is applied to stop bleeding and ensure that the trauma does not bleed [1].
The zygomatic part of the inlet knife is centered on the fixed point and the release procedure is performed outward and downward, with the knife line parallel to the dermatome, i.e., parallel to the frontal surface, and the knife body perpendicular to the dermatome, stabbing rapidly into the subcutaneous area and reaching the periosteal surface. The blade was allowed to float naturally and fixed in this position. After reversing the position of the incision line parallel to the periosteal surface and making a fan-shaped spatula peel along the periosteal surface downward and posteriorly for 3 to 5 strokes, pressure was applied to stop bleeding and ensure that the trauma did not bleed.
The needle knife into the mandible is centered on the fixed point, the incision line is parallel to the periosteal surface of the mandible, and the needle knife is quickly pierced into the subcutaneous, straight to the periosteal surface. The blade is allowed to float naturally and is fixed on the periosteal surface. Then, after peeling in a fan shape for 3 to 5 cuts along the periosteal surface in a dorsal direction, pressure is applied to stop bleeding and ensure that the trauma does not bleed [1].
1.5 Treatment assessment criteria
(1) Cure: complete disappearance of facial muscle spasm symptoms and return to normal.
(2) Improvement: the symptoms of facial muscle spasm basically disappeared and improved significantly compared with those before treatment.
(3) Invalid: no change in the symptoms of facial muscle spasm before acupuncture treatment.
2.Results
56 patients were treated by acupuncture: 45 cases were cured, accounting for 80,36%, 11 cases were improved, accounting for 19,64%, with an overall efficiency of 100%.
3.Discussion
Facial muscle spasm is a relatively common disease in clinical practice, and it is also a difficult disease to cure. The etiology of facial muscle spasm is still unclear, and no matter what causes facial spasm, it is caused by excessive excitability of facial muscle nerve, and this pathogenetic process has not changed. Therefore, based on this pathological process, the acupuncture technique is used to cut off part of the facial nerve endings to reduce the excitability of the facial nerve, thus relieving the symptoms of facial muscle spasm. Through several years of clinical practice, this treatment method has proven to be effective, less painful and less expensive for patients, and is worthy of clinical promotion.