Basic and Clinical Research Review of the Effects of Acupuncture and Moxibustion on Peripheral Facial Nerve Paralysis / 全日本鍼灸学会雑誌

There is little common understanding among acupuncturists regarding the poor prognosis for peripheral facial paralysis, evaluation methods, precautions during treatment, including acupuncture and moxibustion treatment. Cooperation among relevant occupations is also a major issue. Currently, the treatment of paralysis is focused on how to minimize sequelae during the recovery process of paralysis in cases with poor prognosis. The goal is to prevent sequelae and improve patient quality of life (QOL). For that purpose, it is important to understand the guidelines for medical treatment of paralysis, and like other medical staff, the acupuncturist should provide appropriate medical examination, treatment, self-care guidance, etc., and cooperate with other medical specialists. We hope that this seminar will provide a common understanding of the pathophysiology and evaluation methods of paralysis, precautions for acupuncture and moxibustion treatment, and a consensus of clinical research and the future possibility of using acupuncture and moxibustion in the treatment of paralysis.

Luc’s abscess: The zygomatic route of infection from cholesteatoma

@#Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions.

Involvement of GDNF/PI3K/AKT pathway in promoting facial nerve regeneration using electro acupuncture in a rabbit model of facial nerve crush injury / 中国组织工程研究

BACKGROUND: The mechanism of electroacupuncture on multi-acupoints in the treatment of peripheral facial paralysis is still unknown. Glial cell-derived neurotrophic factor (GDNF) is currently the most effective factor in promoting the survival of motoneurons in vitro, and the PI3K/AKT pathway plays an important role in protecting damaged motoneurons. There is yet no research on GDNF/PI3K/AKT pathway involved in electroacupuncture promoting facial nerve regeneration in rabbits. OBJECTIVE: To observe the effect of electroacupuncture on regeneration after peripheral facial nerve crush injury, and to explore the protective mechanism of electroacupuncture on facial motoneurons through the GDNF/PI3K/AKT signaling pathway. METHODS: Sixty-six adult healthy New Zealand white rabbits provided by the Animal Experimental Center of Southwest Medical University were randomly divided into a normal group and a model group. The facial nerves on the right side in the model group were subjected to a crush injury. Then the animal models were randomly divided into a model control group and an electroacupuncture group. Animals in the model control group recovered naturally, while those in the electroacupuncture group underwent electroacupuncture at Yifeng, Jiache, Sibai, Dicang, Yangbai, and Quanliao acupoints daily for 30 minutes. The improvement of facial paralysis symptoms in experimental animals were observed and scored. Tissue samples were directly taken form the normal group, and pons tissues with facial neurons were taken in the model group at 1, 4, 7, 14, and 28 days postoperatively. The morphologies of facial motoneurons and Nissl bodies were observed by hematoxylin-eosin staining and Nissl staining, respectively. Immunohistochemical techniques and western blot assay were used to detect the protein expression of GDNF, PI3K, AKT, and p-AKT in the facial motoneurons. The study protocol was approved by the Animal Ethics Committee of Southwest Medical University with approval No. 20170120001. RESULTS AND CONCLUSION: The symptoms of facial paralysis were that the animal’s mouth was drooped at the affected side, with lodging tentacles and the movement being weakened, and the eyelids that could not be lifted, which recovered faster and more completely in the electroacupuncture group than the model control group. The morphological changes of facial neurons and changes of Nissl bodies in the electroacupuncture group were lighter than those in the model control group. At each time point postoperatively, the stronger GDNF immune response could be seen in the electroacupuncture group, and the number of GDNF-positive cells was higher than that of the model control group except 1 day postoperatively (P < 0.001). The expressions of GDNF, PI3K, p-AKT proteins in the facial motoneurons were significantly increased in the electroacupuncture group compared with the model control group (P < 0.05; P < 0.01; P < 0.001). To conclude, electroacupuncture can effectively treat the peripheral facial paralysis caused by the crushed injury of facial nerve and promote the recovery of facial neurons. The up-regulation of GDNF expression in the facial motoneurons and the activation of PI3K/AKT signaling pathway may be the underlying protective mechanism of electroacupuncture.

Acupuncture Treatment for a Patient with Facial Nerve Paralysis Due to the Operation of Benign Parotid Gland Tumor / 日本東洋医学雑誌

The patient was a 44-year-old man with right facial paralysis as the main complaint. Upon resection of a be­nign parotid gland tumor (6 cm in diameter), one of the buccal branches of the right facial nerve was severed. Immediately after the surgery, facial nerve paralysis occurred in the areas innervated by the buccal and marginal mandibular branches. Therefore, on the 5th day after the surgery, acupuncture was started. The paralyzed facial site was treated weekly for 15 minutes by inserting a disposable acupuncture needle (40 mm in length and 0.16 mm in thickness) about 5 mm deep into the site. As a result, the discomfort around the right ear was alleviated and the right facial nerve paralysis was gradually improved and cured in 6 months after the onset. Acupuncture may have prevented secondary changes such as tissue scarring and atrophy after the surgery, and promoted healing. The paralysis of the areas innervated by the buccal branches may have been improved through re­rooting from the other branches in the periphery region of the neurectomy site. The present case is informative in considering the indications of acupuncture.

Estenosis congénita aislada del conducto auditivo interno como causa de hipoacusia neurosensorial unilateral y paresia del nervio facial / Congenital internal auditory canal stenosis presenting with unilateral sensorineural hearing loss and facial nerve dysfunction

RESUMEN La estenosis del conducto auditivo interno con aplasia/hipoplasia del nervio cocleovestibular es una patología muy infrecuente. Suele ser unilateral y puede acompañarse de aplasia/hipoplasia del nervio facial y otras malformaciones del oído interno. Se presentan aquí dos casos clínicos de pacientes pediátricos con estenosis del conducto auditivo interno unilateral con compromiso del séptimo y octavo par craneal ipsilateral. Se describen las historias y evaluaciones clínicas, hallazgos audiovestibulares, hallazgos imagenológicos, tratamientos indicados y sus resultados.

ABSTRACT Congenital internal auditory canal stenosis associated with aplasia/hypoplasia of the cochleovestibular nerve is a very infrequent pathology. It is usually unilateral and may be accompanied by aplasia/hypoplasia of the facial nerve and other malformations of the inner ear. We hereby present two clinical cases of pediatric patients with congenital internal auditory canal stenosis, with involvement of the seventh and eighth ipsilateral cranial nerve. The medical histories and clinical evaluations, audiovestibular findings, imaging findings, treatments and their results are described.

Tumores de glándula parótida: experiencia quirúrgica Hospital Guillermo Grant Benavente / Parotid gland tumors: surgical experience Hospital Guillermo Grant Benavente

RESUMEN Introducción: La glándula parótida es el sitio más común de tumores de glándulas salivales, correspondiendo al 75%-85% de éstos y al 3% de todos los tumores de cabeza y cuello. Ochenta por ciento de ellos corresponden a tumores benignos. Objetivos: Analizar la experiencia quirúrgica en tumores parotídeos operados en el Hospital Guillermo Grant Benavente. Material y método: Revisión de todos los pacientes con tumores parotídeos operados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, del Hospital Guillermo Grant Benavente entre enero del año 2011 y abril del año 2016. Las cirugías fueron realizadas por el mismo equipo quirúrgico. Se registraron datos demográficos, clínicos, quirúrgicos, histológicos y resultados posoperatorios. Resultados: En el periodo descrito se operó un total de 94 pacientes. 84,3% correspondieron a tumores benignos y 15,7% a tumores malignos. El 62,9% corresponde a pacientes de sexo femenino y 37,1% de sexo masculino, representando una relación de 1,69:1. La incidencia de parálisis facial transitoria fue de 16,1%, y de ellos solo un paciente mantuvo una parálisis permanente. Conclusión: Los tumores malignos representaron el 15,7%, siendo menor a lo reportado en la literatura. Se presenta una gran serie de tumores parotídeos tratados quirúrgicamente a nivel nacional, con una baja tasa de complicaciones.

Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.

Management of Post Traumatic Facial Nerve Palsy: A Hospital Based Study

Background: Facial nerve loss of motion by injury is normal cause after idiopathic. Facial paralysis accordingly of intra cranial, intra fleeting and additional transient limit harm or break and both. Sudden and prompt facial nerve paralysis require early surgical intervention for better result. Facial nerve decompression and termino- terminal anastomosis surgical intervention had done in present study. Methods: A prospective study of the 15 cases of traumatic facial nerve palsy attending Department of Otorhinolaryngology, Government Medical College, Shivpuri, MP. The complete clinic examination, otoscopic, audio logical, topo diagnostic, and radiological evaluation were done in all the patients. The outcome of these patients were done on the House-Brackmann nerve grading system. Results: All patients have infra nuclear type of facial nerve palsy. The maximum incidence of facial nerve paralysis found in the age group between 26 to 35 years. Out of 15 patients ,12 patients were normal hearing. Suprachordal (54%) involvement is the most common site of lesion in traumatic facial nerve paralysis. Conclusions: Sudden and immediate onset facial nerve paralysis need early surgical intervention for better outcome .facial nerve decompression were better outcome comparing to termino terminal anastmosis. The facial nerve paralysis prognosis depends upon degree of paralysis, duration of paralysis, site of injury and patients’ factors.

Per-oral cross-facial sural nerve graft for facial reanimation / 대한악안면성형재건외과학회지

BACKGROUND: Cross-facial nerve graft is considered the treatment of choice for facial reanimation in patients with unilateral facial palsy caused by central facial nerve damage. In most cases, a traditional parotidectomy skin incision is used to locate the buccal and zygomatic branches of the facial nerve. METHODS: In this study, cross-facial nerve graft with the sural nerve was planned for three patients with facial palsy through an intraoral approach. RESULTS: An incision was made on the buccal cheek mucosa, and the dissection was performed to locate the buccal branch of the facial nerve. The parotid papillae and parotid duct were used as anatomic landmarks to locate the buccal branch. CONCLUSIONS: The intraoral approach is more advantageous than the conventional extraoral approach because of clear anatomic marker (parotid papilla), invisible postoperative scar, reduced tissue damage from dissection, and reduced operating time.

Management of the paralyzed face using temporalis tendon transfer via intraoral and transcutaneous approach / 대한악안면성형재건외과학회지

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a relatively minimally invasive technique for the dynamic reanimation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The aim of this article is to review the technique of temporalis tendon transfer involving transferring of the coronoid process of the mandible with the insertion of the temporalis tendon via intra-oral and transcutaneous approach.

Parálisis facial periférica bilateral como presentación inicial del síndrome de Guillain-Barré: informe de un caso / Bilateral facial nerve paralysis as initial manifestation of guillain-barré syndrome: a case report

El síndrome de Guillain-Barré (SGB) es un grupo heterogéneo de alteraciones neurológicas relacionadas que afectan los nervios periféricos del cuerpo. Generalmente se produce después de una infección aguda que favorece a la aparición de una respuesta autoinmune contra las moléculas de los gangliósidos de la mielina de los nervios periféricos. La parálisis facial periférica bilateral es una manifestación neurológica rara (0,3%-2% de los casos) y puede deberse a múltiples etiologías, entre las que se destaca el SGB. Se presenta el caso de un paciente de 39 años que consultó al servicio de urgencias del hospital Universitario del Caribe por parálisis facial bilateral asociada a deterioro motor progresivo y disautonomía. Se realizaron estudios que documentan SGB y se inicia manejo médico con inmunoglobulina intravenosa. El paciente presenta mejoría clínica notoria de su cuadro clínico y es dado de alta del hospital. La parálisis facial periférica bilateral es una entidad neurológica rara que puede asociarse con el síndrome de Guillain-Barré. Es necesario hacer el diagnóstico diferencial respecto de otras entidades clínicas que cursan con parálisis facial periférica bilateral. Se debe iniciar precozmente con inmunoglobulina intravenosa para aumentar la probabilidad de recuperación. El pronóstico es bueno en la mayoría de los casos.

Guillain-Barré syndrome (GBS) is a heterogeneous group of related neurological disorders that affect the peripheral nerves. Generally, it occurs after an acute infection that favors the occurrence of an autoimmune response against the myelin gangliosides molecules of the peripheral nerve. Bilateral peripheral facial nerve paralysis is a rare neurological symptom (0.3%-2% of cases) and may be due to multiple etiologies; among which GBS emerge. The case of a 39 years old patient who consulted by bilateral facial nerve paralysis associated with progressive motor impairment and dysautonomia, is presented. Studies documented GBS. Subsequently, the patient presents successful improvement of his symptoms after intravenous immunoglobulin use and is discharged from the hospital. Bilateral peripheral facial palsy is a rare neurological condition that can be associated with Guillain-Barre syndrome. It is necessary to make the differential diagnosis with other clinical entities presenting with bilateral facial palsy. Intravenous inmunoglbulin should be initiated early to increase the probability of recovery. The prognosis is good in most cases.

A Case of Facial Nerve Paralysis Following Parotid Abscess Treated by Catheter Drainage / 대한이비인후과학회지

Facial nerve paralysis is one of the complications of parotid abscess. Although a few cases of benign tumor and inflammatory condition of parotid gland with the facial nerve paralysis have been reported, the occurrence of facial nerve palsy following parotid abscess without coexisting tumor is very rare. The mechanism of facial nerve paralysis is not clear, but facial nerve paralysis is usually improved after the treatment of parotid abscess. The treatment of parotid abscess is composed of antibiotics based on proper culture study and drainages. Most of parotid abscess is drained by surgical approach, but catheter drainage is also recommended for selected patients. Here, we report a case of parotid abscess treated by pig-tail catheter drainage.

Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention

PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.

Delayed Facial Nerve Paralysis after Tympanomastoid Surgery: The Potentiality of Fungal Infection and Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the clinical courses and clinical outcomes of delayed facial nerve paralysis (DFNP) after middle ear and mastoid surgery. SUBJECTS AND METHOD: In our hospital, postoperative DFNP occurred in 13 cases among the patients who underwent ear surgery from December 2000 to February 2010. During the same period, another 4 cases with postoperative DFNP were diagnosed at a local clinic. We assessed the degree of DFNP by using House-Brackmann grade (HBG) and separated 8 patients in grade II, 6 patients in grade III and 3 patients in Grade IV. Among 17 patients, DFNP occurred after open cavity mastoidectomy in 11 cases and after closed cavity mastoidectomy in the rest of 6 cases. RESULTS: Among 17 postoperative DFNP, fungal infections were found in three patients. Patients for whom antifungal agent was relatively delayed in application, their condition did not improved. CONCLUSION: After treatment, most of patients recovered within 1 month and there were no other associated infection during hospitalization. We suggest that antifungal agents should be used as soon as possible when patients complain about DFNP following open cavity mastoidectomy.

A Case of Temporal Bone Myeloid Sarcoma / 대한이비인후과학회지

Myeloid sarcoma is a rare solid, extramedullary tumor composed of immature granulocytes, occurring in a granulocytic leukemia. In rare cases, they can represent the initial manifestation of a relapsed form in patients with acute myelogenous leukemia in remission status. There have been only a few reports of myeloid sarcoma involving the temporal bone. We report a case of facial nerve paralysis caused by temporal bone myeloid sarcoma as the presenting symptom of leukemic relapse in a 27-year-old female, who was affected by acute myelogenous leukemia.

Facial paralysis after spine surgery : A case report

diopathic facial nerve paralysis after surgery is not common but has clinical significance. We report a case of facial nerve paralysis in the immediate postanesthetic period after cervical spine surgery. A 41-year-old man with cervical herniated disc was scheduled for cervical laminectomy. After uneventful surgery, he suffered from left facial numbness and weakness. Imaging study and audiogram couldn't reveal any anatomic abnormality except Thornwaldt cyst. Conservative treatment with steroids and antivirals resolved his symptoms until 16th day after surgery.

Facial Nerve Paralysis and Surgical Management

The facial nerve coursing through the temporal bone provides a challenge to the otologic surgeon. Advances in surgical instrumentation and refinements of surgical strategies enable the otologist to uncover the entire course of the facial nerve safely from brainstem to its exit from temporal bone. The most common cause of facial nerve paralysis is Bell's palsy, followed by traumatic facial paralysis, herpes zoster oticus, and intratemporal tumous lesion. The surgical approaches to the injured facial nerve depend on its causes. Acute, severe facial nerve paralysis caused by viral infection or trauma can be managed by early use of transmastoid approach, middle cranial approach, or combined approach. In case of intratemporal benign tumor with favorable facial function, great care must be taken not to damage the facial nerve with nerve preservation technique. However, in malignant tumor with favorable facial function, the priority must be placed on the complete resection than to the facial nerve preservation. In consideration of selecting surgical technique of facial nerve paralysis reconstruction, clinician must find out the cause, degree and duration of paralysis for the appropriate technique.

The diagnostic value of high resolution CT in assessment of temporal bone traumatic facial nerve paralysis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the diagnostic value of high resolution CT for temporal bone traumatic facial nerve paralysis and the guidance significance for surgery.Method:Twenty-nine patients of traumatic facial nerve paralysis were investigated.The predictive diagnosis was made according to the clinical data and the image features of HRCT,then a comparative analysis of the preoperative image features and the surgical findings were carried out.Result:The trend of temporal bone fracture displayed on the CT scan was basically consisted with the surgical findings.The direct CT signs of facial nerve injury include the bone fracture line went through the tube,bone tube rupture or continuity interruption,while the indirect CT signs include local incrassation of the facial nerve,lower bone density of the tube,geniculate fossa expansion,oppressed facial nerve,et al.The predictive diagnostic accordance rates of all the image features were above 90%as to the surgical findings.Conclusion:High resolution CT could localize the trend of temporal bone fracture,and is helpful to estimate the extent of facial nerve injury and other complications.High resolution CT could provide reliable basis for clinical diagnosis and trotment.

Application of Alternate Electroacupuncture Waveforms in Treatment of Peripheral Facial Paralysis / 中国康复理论与实践

@#Objective To study the application of waveforms in treatment of peripheral facial paralysis with electroacupuncture. Methods 66 patients with peripheral facial paralysis were divided into two groups: treatment group (34 cases) and control group(32 cases). All the patients were acupunctured at the similar points with electroacupuncture, while the disperse-dense wave and the discontinuous wave were used successively in the treatment group, and the disperse-dense wave was used alone in the control group. Results There were significant differences between the two groups in the total effective rate and the days for cure (P<0.01). Conclusion The effect of alternate disperse-dense wave and discontinuous wave is superior to that of disperse-dense wave alone in electroacupuncture treatment for peripheral facial paralysis.

Treatment with complementary oriental medicine for two cases of paralysis / 全日本鍼灸学会雑誌

We experienced two cases of paralysis in the facial area treated with complementary oriental medicine.<br>Case 1<br>A 68-year-oid female presented herself in the emergency department at the Iwate Medical University with a complaint of facial deformity.<br>She was diagnosed as left facial paralysis with ptosis and drooping of a corner of the mouth.<br>In our clinic, she was first treated with stellate ganglion block, steroids and antivirals.<br>One week later, we adopted trans-cutaneous electric stimulation therapy and 2 months later used acupuncture. All the symptoms disappeared over a 9 month period.<br>Case 2<br>A 49-year-old female was referred to Iwate Medical University Department of Oral Maxillo-facial Surgery because of her facial itching and hypesthesia.<br>She was diagnosed as herpes zoster and transferred to our clinic. She was treated with stellate ganglion block, trans-cutaneous electric stimulation therapy and steroids.<br>One month later, her symptoms were partially lessened.<br>Two months later, a diagnosis of peripheral trigeminal nerve paralysis of the fist, second and third divisions, was established after a complete medical examination.<br>After that, her paresthesia gradually changed neuralgia-like in spite of our clinical care.<br>Five years later, her symptoms improved to a certain extent with the use of acupuncture.<br>Conclusion<br>We conclude that oriental medicine is effective in the treatment of paralysis.

A case report of reconstruction of facial paralyzed patient