Medical Management of Acute Facial Paralysis

Efficacy analysis of electroacupuncture plus TDP in the treatment of peripheral facial paralysis: a systematic review and meta-analysis

Objective

This study intends to carry out a systematic review and meta-analysis of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis.

Methods

CNKI, VIP, Wanfang, PubMed, Embase and Cochrane databases were searched for literatures on randomized or quasi-randomized controlled trials of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis, and the references of the included studies were searched. Meta-analysis was performed using Stata15.0 software after risk of bias, quality assessment, and data extraction of the included articles by two reviewers independently.

Results

Fifteen articles were finally included, with approximately 1,568 participants (920 in the treatment group and 648 in the control group). Meta-analysis showed that the effective rate of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis was not significantly different from other treatment methods ([RR = 1.05, 95%CI (0.97, 1.12), p = 0.226]), and the recovery rate was better than other treatment methods ([RR = 1.14, 95%CI (1.05, 1.24), p = 0.002]). Subgroup analysis showed that when stratified by the inclusion of minors in the study population, it was observed that in studies including minors, the combination of electroacupuncture and TDP therapy demonstrated superior efficacy in treating peripheral facial paralysis compared to other therapeutic modalities [OR = 1.14, 95% CI (1.03, 1.25), p = 0.011]. Conversely, in studies where the population comprised solely adults, no significant difference was found between the combination therapy and other treatments [OR = 1.15, 95% CI (0.99, 1.33), p = 0.059]; whether electroacupuncture alone or other treatment methods, the recovery rate of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis was better than other methods.

Conclusion

Electroacupuncture combined with TDP is superior to other treatment methods in the treatment of peripheral facial paralysis.

Fixel-Based Analysis of White Matter Alterations in Facial Palsy

Predicting individual prognosis is difficult despite various risk factor studies, due to the complex recovery involving peripheral nerve restoration and cerebral plasticity. This study uses fixel-based analysis (FBA) to better understand neural pathway alterations, hypothesizing that FBA can effectively link functional outcomes with diffusion metrics in the process of rehabilitation. The authors recruited 50 participants including 30 patients and 20 healthy controls into the study. All of them underwent assessment 3 months and 6 months after injury. Both whole-brain fixel-based analysis and tract of interest analysis were performed. The authors observed multiple regions including the superior corona radiata, posterior limb of the internal capsule, and cerebral peduncle displaying significant changes of FD (fiber density), FC (fiber-bundle cross-section), and FDC (fiber density and cross-section). Patients with unfavorable outcomes showed increased FD in the ipsilesional side and decreased FD in the contralesional side compared with patients with favorable outcomes. In addition, FD values of the contralesional side exhibited positive correlations with differences in FGS at 3 months and 6 months. Conversely, FD values in the ipsilesional side showed a negative correlation. Our findings suggest that FD metrics within the corticobulbar tract could serve as predictive biomarkers for symmetry outcomes. Thus, FBA holds promise for early estimation of behavioral outcomes in facial palsy, guiding more targeted interventions.

Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period

INTRODUCTION

Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them.

METHODS

Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation.

RESULTS

Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population.

DISCUSSION

Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published.

CONCLUSION

Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.

Prevalence, Etiology, Risk Factors, and Complications of Facial Nerve Palsy at King Abdulaziz Medical City: A Multicenter Study

BACKGROUND

Facial nerve palsy is a condition of nerve damage that results in impaired facial movement on one or both sides of the face.

OBJECTIVES

This multicenter study aimed to determine the prevalence of facial nerve palsy and evaluate the association between its risk factors and complications to identify its etiology among patients admitted to King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia, between 2016 and 2023.

METHODS

A retrospective cross-sectional study was conducted to obtain data from medical records using the best care system for patients with facial nerve palsy. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States), Chi-square test, t-test, and ANOVA. The level of statistical significance was set at p<0.05.

RESULTS

 The study involved 123 patients, with 0.0164% prevalence. Bell's palsy was the most common etiology, accounting for 81.8% of cases, followed by head injuries, dental trauma, otitis media, stroke, and head and neck tumors. Obesity was the most significant risk factor, followed by upper respiratory problems. Hypertension and diabetes exert similar effects. Facial asymmetry, ophthalmic complications, and eye twitching were the most common complaints followed by speech difficulties, psychological and social effects, mouth twitching, and synkinesis.

CONCLUSION

 Facial nerve palsy is common in this region. We recommend health education sessions to increase public awareness and provide preventive strategies to reduce the complications of facial nerve damage. We recommend further research on the association between the risk factors and complications of facial nerve palsy.

Bell Palsy: Facts and Current Research Perspectives

Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.

Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience

BACKGROUND

Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments.

METHODS

Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed.

RESULTS

Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III.

CONCLUSIONS

Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.

Stylohyoid fracture resulting in facial paralysis

A female patient in her early 30s was referred to the otology clinic for progressive left facial paralysis. Two weeks prior to the onset of the paralysis, she had heard a loud cracking sound when drinking water. A CT scan showed a left styloid fracture near the stylomastoid foramen, compressing the facial nerve. Varicella IgG and IgM were negative, but the patient was started on a tapering course of steroids and valacyclovir. Approximately 1 month after the original incident, her left facial nerve paralysis improved. This report describes the unusual cause of facial paralysis and discusses the importance of history taking and imaging studies.

Diagnostic values of leukocyte, neutrophil, and neutrophil to lymphocyte ratio in distinguishing central facial paralysis from peripheral facial paralysis

OBJECTIVE

Misdiagnosis of central facial palsy (CFP) as peripheral facial palsy (PFP) can lead to serious consequences clinically. It is unknown whether the leukocyte counts (leukocyte), neutrophil counts (neutrophil), and neutrophil to lymphocyte ratio (NLR) can be used to distinguish CFP from PFP.

METHODS

Of the total 152 patients admitted for acute facial paralysis, 76 CFP patients (CFP group) caused by acute ischemic stroke (AIS) and 76 PFP cases (PFP group) without AIS were enrolled in this retrospective study. The levels of blood leukocyte, neutrophil, lymphocyte, platelet counts (platelet), NLR, and platelet to lymphocyte ratio (PLR) before or upon admission were recorded and compared between the two groups. The student t-test was adopted for comparison of the mean. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Comparison of AUC was performed using the Z-test.

RESULTS

Compared with PFP group, the levels of leukocyte, neutrophil, and NLR were significantly increased in CFP group (all p < 0.01), and there were still significantly statistical differences (all p < 0.01), even after adjusting for age, gender, and past medical history, while no significantly statistical differences of lymphocyte, platelet, and PLR were found between CFP and PFP (all p > 0.05); furthermore, the AUC in distinguishing CFP from PFP were 0.629, 0.671, and 0.657 for leukocyte, neutrophil, and NLR, respectively, and no significant difference of AUC was observed among leukocyte, neutrophil, and NLR (p > 0.05); finally, the cutoff values (specificity, sensitivity, and Youden index) in distinguishing CFP from PFP were 7.08 × 10⁹/L (65.79%, 57.89%, 0.237) for leukocyte, 4.90 × 10⁹/L (73.68%, 60.53%, 0.342) for neutrophil, and 2.88 (72.37%, 55.26%, 0.276) for NLR, respectively.

CONCLUSIONS

As easy-to-obtain and inexpensive inflammatory biomarkers, leukocyte, neutrophil, and NLR could demonstrate diagnostic values in distinguishing between CFP and PFP.

The psychological and psychosocial effects of facial paralysis: A review

Facial nerve function is essential for a multitude of processes in the face, including facial movement; expression; and functions, such as eating, smiling, and blinking. When facial nerve function is disrupted, facial paralysis may occur and various complications for the patient may result. Much research has been conducted on the physical diagnosis, management, and treatment of facial paralysis. However, there is a lack of knowledge of the psychological and social effects of the condition. Patients may be at an increased risk for anxiety and depression, as well as negative self and social perceptions. This review analyzes the current literature on the various adverse psychological and psychosocial effects of facial paralysis, factors that may play a role, and treatment options that may help improve patients' quality of life.

Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats

PURPOSE

To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system.

METHODS

Ten male Wistar rats (12-15 weeks old), without veterinary diseases, weighing 220-280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected.

RESULTS

The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic.

CONCLUSIONS

The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.

Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study

Temporary facial nerve palsy after parotid tumor surgery ranges from 14 to 65%, depending on surgery, tumor type, and subsite. The study aimed to evaluate the role of Kabat physical rehabilitation in the outcomes of patients affected by severe facial nerve palsy following parotid gland surgery. The results and clinical data of two groups, Kabat and non-Kabat (control), were statistically compared. Descriptive statistics, the multiple linear regression model, difference in difference approach, and the generalized linear model were used. F-Test, Chi-square test, McFadden R-squared, and adjusted R-squared were used to assess the significance. The results showed that the House–Brackmann (HB) stage of patients who had physiotherapy performed were lower than the control group. The decrease of HB staging in the Kabat group at 3 months was −0.71 on average, thus the probability of having a high HB stage decreased by about 13% using Kabat therapy. The results are statistically significant, and indicated that when the Kabat rehabilitation protocol is performed, mainly in the cases of a high-grade HB score, the patients showed a better and faster improvement in postoperative facial nerve palsy.

Clinical analysis of acute peripheral facial palsy in older adults

Objective

Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults.

Methods

A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively.

Results

The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults.

Conclusion

Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.

Research on the application of myofascial induction therapy in the rehabilitation of patients with acute facial palsy: A nonrandomized controlled trial

BACKGROUND

In the healthy body, the fascial system maintains elasticity and coordination of movements. If these functions are destroyed, facial paraly appears. Myofascial induction therapy (MIT), a manual physical therapy method that focuses on restoring altered fascial tissue, is prevalently and widely used in clinical treatment.

OBJECTIVE

The study aimed to observe the application of MIT in the rehabilitation of patients with acute facial palsy.

METHODS

Sixty-eight patients with acute facial palsy were divided into control group and manual treatment group. The control group received drug treatments, such as prednisone, methylcobalamin, and vitamin B1, and instrumental physical therapy, such as semiconductor laser, shortwave therapy, and facial muscle training. In addition to these treatments, the manual treatment group received MIT. Both groups were treated for 4 weeks. The patients were assessed using the following methods: the House-Brackmann facial nerve function evaluation, Sunnybrook facial grading system, facial nerve electrophysiological examination compound muscle action potential (CMAP) amplitude, and blink reflex (BR) R1 latency.

RESULTS

House-Brackmann and Sunnybrook scores and CMAP amplitude and BRR1 latencies were significantly different between the two groups (p <  0.05). Furthermore, the manual treatment group showed greater improvement than the control group (p <  0.05).

CONCLUSIONS

Treatment with MIT promoted better recovery of acute facial palsy and thus may be considered a valid rehabilitation intervention that is worthy of clinical application.

Effect of Penetration Electroacupuncture Combined with Intermediate Frequency Electrotherapy, Facial Acupoint Massage, and Cervical Reduction on Facial Nerve Function and Curative Effect of Senile Refractory Facial Paralysis

Objective

This study aimed to explore the curative effects on senile refractory facial paralysis treated by penetration electroacupuncture combined with intermediate frequency electrotherapy, facial acupoint massage, and cervical reduction on facial nerve.

Methods

106 elderly patients with intractable facial paralysis that were retrospectively analyzed were all admitted from January 2019 to June 2020. The 106 patients were evenly divided into 2 groups according to the treatment method. The control group was treated with penetration electroacupuncture, while the observation group was treated with penetration electroacupuncture plus intermediate frequency electrotherapy + facial acupoint massage + cervical reduction treatment. Then, House–Brackmann (H-B) facial nerve function evaluation, RPA score, TCM syndrome score, disease remission rate, and incidence of adverse events were evaluated and compared between the two groups.

Results

After 4 weeks of treatment, the H-B facial nerve function grading in the observation group was better than that in the control group (P < 0.05). And the disease remission rate after 1 week, 2 weeks, and 4 weeks of treatment was higher than that in the control group (P < 0.05). Meanwhile, the TCM syndrome score and RPA score after 2 weeks and 4 weeks of treatment were better than that in the control group (P < 0.05).

Conclusion

For the elderly patients with refractory facial paralysis, the application of the combined treatment that penetration electroacupuncture + medium frequency electrotherapy + facial acupoint massage + cervical adjustment can significantly improve the facial nerve function and reduce various diseases, and the effect of this combined treatment plan is more significant than that of penetration electroacupuncture treatment.

An unusual case of facial nerve palsy due to minor face trauma: A rare case report

There can be various causes of facial palsy, and sometimes the cause remains unidentified (Bell’s palsy). Among the various causes of facial palsy, trauma is a major one. Depending on the severity of paralysis, traumatic facial palsy can be medically managed using corticosteroid and eye care or with surgical decompression. In selective cases with incomplete facial palsy, radio-imaging studies may not always be required. We present the case of a 13-year-old boy who presented to the primary-level hospital with a complaint of facial palsy following minor trauma to the face (slapped over the face by a friend). His Sunnybrook Score was 63/100. We managed him with prednisolone (1 mg/kg/day) for 2 weeks and then tapered, and with eye care with artificial tears for 6 weeks. There was a complete resolution of symptoms in 6 weeks. Incomplete facial paralysis due to trauma to the face can be managed medically with corticosteroids and proper eye care with artificial tears.

The efficacy and safety of cupping therapy for treating of intractable peripheral facial paralysis: A protocol for systematic review and meta-analysis

BACKGROUND

Peripheral facial paralysis (PFP) is a common clinical neurological disease and the incidence of intractable peripheral facial paralysis is on the rise. Symptoms include crooked mouth and eyes, tearing and shallow nasolabial folds. The disease seriously affects the physical and mental health of patients. At present, a large number of clinical studies have shown that cupping is effective in treating intractable peripheral facial paralysis (IPFP). Therefore, the purpose of this review is to evaluate the effectiveness and safety of cupping in the treatment of refractory peripheral facial paralysis.

METHODS

We will conduct a comprehensive and systematic search of relevant documents in the following databases: Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure (CNKI), Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. The 2 reviewers will be independently completed select research, extract data, evaluate research quality and use the Cochrane risk of bias tool to assess methodological quality. Using revman5.4 software for statistical analysis. The degree of heterogeneity will be Determined through heterogeneity test, to definite whether to adopt a random effects model or a fixed-effects model.

RESULTS

The protocol for the meta-analysis will systematically evaluate the efficacy and safety of cupping therapy for intractable peripheral facial paralysis patients.

CONCLUSION

This study will explore whether or not cupping therapy can be used as one of the non-drug therapies to prevent or treat intractable peripheral facial paralysis.

Translation and Validation of the Facial Clinimetric Evaluation Scale to Spanish

OBJECTIVE

Peripheral facial palsy is a disabling condition; thus, assessing its impact on quality of life is one of the greatest challenges within this discipline. The Facial Clinimetric Evaluation (FaCE) Scale has been validated for this purpose. The aim of this study is to translate and validate the Spanish version of the FaCE Scale.

STUDY DESIGN

We performed a forward-backward translation of the original English FaCE Scale. A pilot test and a posterior prospective validation study were performed.

SETTING

A pilot test and a posterior prospective validation study were conducted in a specialized facial palsy unit in a tertiary hospital.

METHODS

A validation study was carried out in 85 patients to calculate the scale's internal consistency and validity and to compare outcomes with the Sunnybrook Facial Grading System and the Facial Disability Index (FDI).

RESULTS

Internal consistency was evaluated by Cronbach's α coefficient, which showed a value of 0.841 (95% CI, 0.786-0.886). The total FaCE Scale score correlates well with the Sunnybrook, FDI physical function, and FDI social/well-being function scores: r = 0.773, r = 0.883, and r = 0.523, respectively. The FDI social/well-being function has the highest correlation with the FaCE Scale social function domain (r = 0.595).

CONCLUSION

The Spanish version of the FaCE Scale demonstrated a high psychometric property that allows it to be used for clinical practice to assess the quality of life of Spanish-speaking patients with peripheral facial palsy.

Facial nerve palsy in giant-cell arteritis: case-based review

Acute peripheral facial nerve palsy is most frequently idiopathic (Bell's palsy) or virally induced, but can also be due to several other conditions. A rare cause is underlying systemic or autoimmune disease. A 79-year-old man presented with peripheral facial nerve palsy, malaise, and fever. Physical examination revealed tenderness of the left temporal artery and reduced pulsatility. ¹⁸F-FDG-PET/CT and biopsy of the temporal artery confirmed the diagnosis of giant cell arteritis (GCA). Prompt institution of corticosteroid therapy produced rapid decrease in inflammatory markers and gradual improvement of the facial nerve palsy. We searched the MEDLINE, Embase, and Scopus databases to identify previous reports of peripheral nerve palsy in GCA, other vasculitides, and autoimmune diseases. Facial nerve palsy as the presenting symptom of GCA has very rarely been reported. Although temporal artery biopsy is the gold standard for diagnosis, it may be negative in up to one-third of cases. In doubtful cases, imaging can help establish the diagnosis. Ultrasound, 3 T MRI, and ¹⁸F-FDG-PET/CT have all been previously reported to be useful. Peripheral facial nerve palsy may very rarely be the presenting symptom of GCA. Early correct diagnosis is essential for starting appropriate therapy. In patients with atypical features, ¹⁸F-FDG-PET/CT may be useful for establishing the diagnosis.

Effect of Thick-Needle Therapy in Patients with Bell's Palsy at Recovery Stage: A Multi-center Randomized Controlled Trial

OBJECTIVE

To compare the clinical effects of thick-needle therapy (TNT) and acupuncture therapy (AT) on patients with Bell's palsy (BP) at the recovery stage.

METHODS

A total of 146 eligible participants from 3 hospitals in China were randomized into the TNT group (73 cases) and the AT group (73 cases) using a central randomization. Both groups received Western medicine thrice a day for 4 weeks. Moreover, patients in the TNT group received subcutaneous insertion of a thick needle into Shendao (GV 11) acupoint, while patients in the AT group received AT at acupoints of Cuanzhu (BL 2), Yangbai (GB 14), Dicang (ST 4), Xiaguan (ST 7), Jiache (ST 6), Yingxiang (LI 20) and Hegu (LI 4), 4 times a week, for 4 weeks. Both groups received 2 follow-up visits, which were arranged at 1 month and 3 months after treatment, respectively. The primary outcome measure was House-Brackmann Facial Nerve Grading System (HBFNGS) grade. And the clinical recovery rates of both groups were evaluated according to the HBFNGS grades after treatment. The secondary outcome measures included the facial disability index (FDI) and electroneurogram (EnoG). The adverse events were observed and recorded in both groups.

RESULTS

Three cases withdrew from the trial, 2 in the TNT group and 1 in the AT group. There was no signifificant difference in the clinical recovery rates between the TNT and AT groups after 4-week treatment [40.85% (29/71) vs. 34.72% (25/72), P>0.05]. At the 2nd follow-up visit, more patients in the TNT group showed reduced HBFNGS grades than those in the AT group (P<0.01). No significant difference was observed between the two groups in FDI score, EnoG latency and maximum amplitude ratio at all time points (all P>0.05).

CONCLUSION

The clinical effect of TNT was equivalent to that of AT in patients with BP at recovery stage, while the post-treatment effect of TNT was superior to that of AT. (Registration No. ChiCTR-INR-16008409).

Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.