Bell’s Palsy – Facial Paralysis

J Chiropr Med. 2014 Jun;13(2):96-103. doi: 10.1016/j.jcm.2014.06.010.

Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases.

Ng SY1, Chu MH1.

Author information

  • 1Private practice, Wanchai Chiropractic Clinic, Hong Kong, China.

 

Abstract

OBJECTIVE:

The purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy.

CLINICAL FEATURES:

Two patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow.

INTERVENTION AND OUTCOME:

Monochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow.

CONCLUSION:

These 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy.

 
Lasers Med Sci. 2014 Jan;29(1):335-42. doi: 10.1007/s10103-013-1352-z. Epub 2013 May 26.

Efficacy of high and low level laser therapy in the treatment of Bell's palsy: a randomized double blind placebo-controlled trial.

Alayat MS1, Elsodany AM, El Fiky AA.
 
  • 1Department of Basic Science, Faculty of Physical Therapy, Cairo University, 7 Ahmed Elziat Street from Eltahrir Street, Cairo, Egypt, mohsalahpt@hotmail.com.

Abstract

The aim of the present study was to investigate and compare the effects of high intensity laser therapy (HILT) and low level laser therapy (LLLT) on the treatment of patients with Bell's palsy. Forty-eight patients participated in and completed this study. The mean age was 43 ± 9.8 years. They were randomly assigned into three groups: HILT group, LLLT group, and exercise group. All patients were treated with facial massage and exercises, but the HILT and LLLT groups received the respective laser therapy. The grade of facial recovery was assessed by the facial disability scale (FDI) and the House-Brackmann scale (HBS). Evaluation was carried out 3 and 6 weeks after treatment for all patients. Laser treatments included eight points on the affected side of the face three times a week for 6 successive weeks. FDI and HBS were used to assess the grade of recovery. The scores of both FDI and HBS were taken before as well as 3 and 6 weeks after treatment. The Friedman test and Wilcoxon signed ranks test were used to compare the FDI and HBS scores within each group. The result showed that both HILT and LLLT significantly improved the recovery of patients with Bell's palsy. Moreover, HILT was the most effective treatment modality compared to LLLT and massage with exercises. Thus, both HILT and LLLT are effective physical therapy modalities for the recovery of patients with Bell's palsy, with HILT showing a slightly greater improvement than LLLT.

 
J Chiropr Med. 2013 Dec;12(4):288-91. doi: 10.1016/j.jcm.2013.10.001.

Chiropractic management of Bell palsy with low level laser and manipulation: a case report.

Rubis LM.
  • Chiropractor, ANEW Medical and Rehabilitation, Joliet, IL.

Abstract

OBJECTIVE:

The purpose of this case report is to describe chiropractic management including the use of cold laser and chiropractic manipulation in the treatment of a patient with Bell palsy.

CLINICAL FEATURES:

A 40-year-old male patient had a 10-day history of facial paralysis on his left side, including the inability to close his left eye, which also had tearing and a burning sensation. The patient had trouble lifting his left lip and complained of drooling while brushing his teeth. There was no previous history of similar symptoms or a recent infection. Prior treatment had included oral steroids.

INTERVENTION AND OUTCOME:

The patient was treated with lowlevel laser therapy and chiropractic manipulation 2 times in 4 days. The laser was applied along the course of the facial nerve for 30 seconds at each point and for 1 minute at the stylomastoid foramen. The laser used was a GaAs class 4 laser with a wavelength of 910 nm. The patient perceived a 70% to 80% improvement of facial movement after the first treatment. After the second treatment, the patient reported full control of his facial movements.

CONCLUSION:

A patient with acute facial paralysis appeared to have complete resolution of his symptoms following the application of lowlevel lasertherapy and chiropractic manipulation.

J Altern Complement Med.  2012 Nov 9. [Epub ahead of print]

Low-Level Laser Therapy in Pediatric Bell's Palsy: Case Report in a 3-Year Old Child.

Fontana CR, Bagnato VS.

Source

1 Department of Clinical Analysis, School of Pharmaceutical Sciences, Univ Estadual Paulista (UNESP) , Araraquara, SP, Brazil .

Abstract

Abstract Objectives: The objective of this study was to apply low-level laser therapy (LLLT) to accelerate the recovery process of a child patient with Bell's palsy (BP).

Design: This was a prospective study. Subject: The subject was a 3-year-old boy with a sudden onset of facial asymmetry due to an unknown cause.

Materials and methods: The low-level laser source used was a gallium aluminum arsenide semiconductor diode laser device (660 nm and 780 nm). No steroids or other medications were given to the child. The laser beam with a 0.04-cm(2) spot area, and an aperture with approximately 1-mm diameter, was applied in a continuous emission mode in direct contact with the facial area. The duration of a laser session was between 15 and 30 minutes, depending on the chosen points and the area being treated. Light was applied 10 seconds per point on a maximum number of 80 points, when the entire affected (right) side of the face was irradiated, based on the small laser beam spot size. According to the acupuncture literature, this treatment could also be carried out using 10-20 Chinese acupuncture points, located unilaterally on the face. In this case study, more points were used because the entire affected side of the face (a large area) was irradiated instead of using acupuncture points.

Outcome measures: The House-Brackmann grading system was used to monitor the evolution of facial nerve motor function. Photographs were taken after every session, always using the same camera and the same magnitude. The 3-year-old boy recovered completely from BP after 11 sessions of LLLT. There were 4 sessions a week for the first 2 weeks, and the total treatment time was 3 weeks.

Results: The result of this study was the improvement of facial movement and facial symmetry, with complete reestablishment to normality.

Conclusions: LLLT may be an alternative to speed up facial normality in pediatric BP.

Zhongguo Zhen Jiu. 2008 Apr;28(4):265-6.

Observation on therapeutic effect of acupuncture combined with He-Ne laser radiation on facial paralysis

[Article in Chinese]

Hou YL, Li ZC, Ouyang Q, Li X, Li H, Zhao M.

Section of Physiotherapy, General Hospital of Beijing Military Area, Beijing 100700, China.

OBJECTIVE: To compare therapeutic effects of acupuncture combined with He-Ne laser radiation and western medicine on facial paralysis.

METHODS: Ninety-seven cases were randomly divided into an acupuncture with laser group (n=55) and a medication group (n=42). The acupuncture with laser group were treated by acupuncture at main points, Dicang (ST 4), Jiache (ST 6), Sibai (ST 2), Qianzheng, Xiaguan (ST 7), Yingxiang (LI 20), Yangbai (GB 14), Yuyao (EX-HN 4), Yifeng (TE 17), Hegu (LI 4), in combination with He-Ne laser radiation; the medication group were treated with routine western medicine including intravenous dripping of low molecular dextran, compound Danshen and ATP injections, intramuscular injection of VitB1 and VitB12 , and oral administration of oryzanol and prednisone. Seven days constituted one course. After two courses their therapeutic effects were observed.

RESULTS: The cured rate was 81.8% in the acupuncture with laser group and 45.20% in the medication group with a significant difference between the two groups(P<0.01).

CONCLUSION: The therapeutic effect of acupuncture combined with He-Ne laser radiation on facial paralysis is better than that of routine medication.

Vopr Kurortol Fizioter Lech Fiz Kult. 2003 Sep-Oct;(5):28-30.

Laser therapy and cryomassage in rehabilitation of patients with facial nerve neuropathy

[Article in Russian]

Maslovskaia SG, Gusarova SA, Gorbunov FE, Strel'tsova EN.

Cryomassage and its combination with low-intensity infra-red laser radiation have been introduced as a novel treatment of facial nerve neuropathy (FNN) in 32 patients. Electrophysiological investigations (facial thermography, classical electrodiagnosis, electromyography of the mimic muscles) and clinical data including those of long-term follow-up show that neither cryomassage nor infra-red laser radiation studied promote transformation of facial tissues in FNN patients. Use of the above factors is effective in a preclinical stage of forming contracture of the mimic muscles. Special techniques of application of local hypothermia and laser radiation can be used in multimodality treatment of both the established contracture and sluggish paresis of the facial muscles.

Used by the kind permission of the Czech Society for the Use of Laser in Medicine, www.laserpartner.org

Laser Regeneration of Nerve Injuries in Children

Laser Regeneration of Nerve Injuries in Children

C. AILIOAIE*, L.M. AILIOAIE**, D.A. CHIRAN ***

* Faculty of Medicine, "Gr.T. Popa" University of Medicine & Pharmacy, Iasi, Romania

** Department of Medical Physics, "Al.I. Cuza" University, Iasi, Romania

*** Laser Clinic, Iasi, Romania

Summary

The current research makes a systematic examination of the influence of Low Level Laser Therapy (LLLT) in the regeneration of nerves in children, diagnosed with facial asymmetry, brachial plexus, or radial nerve injuries. Thirty-one patients (no case of central paralysis) were randomly separated into two groups. Group 1 (16 patients) was treated using low-level laser radiation and group 2 (15 patients – the control group) was applied classical methods of treatment. Two diode lasers were used (670 and 830 nm wavelengths & 100 mW respectively 300 mW max. output power). All the children were followed closely with active and passive corrective exercises. The final analysis clearly indicates the validity of this new treatment technique, as 87.5% of the patients treated with laser displayed a complete recovery, reported to only 60.0% of the patients in the control group.

Introduction

Peripheral nerve palsies in newborns and infants are known to occur with a frequency between 2-6% of cases [1]. The causes of palsies are very diverse; those of central nervous system are rare. The most frequently observed nerve injuries are those involving the facial nerve and the brachial plexus. Usually, facial palsy is a peripheral paralysis that results from pressure over the facial nerve in utero, from efforts during labor, or from forceps during delivery. Facial asymmetry may be present at birth or may develop later, suddenly or gradually, unilaterally or bilaterally [2, 3]. LLL radiation actions on electrophysiological parameters of nerves [4], and represents a hope in treating these problems [5, 6, 7].

Materials and Methods

Thirty-one patients were randomly separated into two groups: group 1 (16 patients) was treated using low-level laser radiation, and group 2 (15 patients) was applied classical methods of treatment. In the present research both groups did not present any case of central paralysis, but the local traumatic etiology was the most frequently observed. At the newborns treated for facial asymmetry, the paralysis did not disappear spontaneously in a few days after delivery. See Table 1 for patient data.

Table 1

Features Group 1

(n=16)Group 2

(n=15)Mean Age (months)1.671.71Sex  Males50.0% (8)46.7% (7)Females50.0% (8)53.3% (8)Diagnosis  Facial Asymmetry62.5% (10)60.0% (9)Erb-Duchenne Paralysis25.0% (4)26.7% (4)Radial Paralysis12.5% (2)13.3% (2)Etiology  Traumatic Injuries

Obstetrical Causes at Birth

Other Emergency Injuries56.3% (9)60.0% (9)Acute Injuries

Acute Otitis Media

Facial Neuritis25.0% (4)20.0% (3)Congenital Bell’s Palsy

(Unknown Etiology)18.7% (3)20.0% (3)

Group 1 received LLL therapy every other day, three times a week, 12 days per month, during a 3-month period. The clinical work has been performed with Med 700 (670nm, Lasotronic – Switzerland) and Maestro (830nm, Medicom – Czech Republic). The treatment parameters were: density of energy in range of 2.0 – 8.0 J/cm2; pulsed wave – 8.2 Hz, in IR domain. Every paralysis was treated following the trajectory of the nerve from its origins, applying the treatment in 10 – 20 irradiation points by contact mode. In the case of the facial nerve there was applied a density of energy of 8.0 J/cm2 on its intaosseus trajectory. Group 2 was applied classical treatment. All the children were closely followed with active & passive corrective exercises. The integrity of the facial nerve was evaluated testing 10 muscular groups belonging to medial and lateral half of the face (See Figure 1). In this clinical test, points have been given for each muscular group, and then added, as follows: absence of contraction = 0 p, normal contraction = 3 p.

Figure 1.

Results and Discussions

The efficiency of LLLT was very good.

The improvement began after 12 sessions and the total recovery of function was observed at the end of treatment. Figure 2 displays the evolution of the motricity score in the tested patients, diagnosed with facial asymmetry.

The recorded results showed that the response after the first stage of treatment was positive in 43.7% of the children in LLLT group, comparatively with only 13.3% of the patients in the control group. The final analysis proved that 87.5% of the patients treated with laser displayed a complete recovery, reported to only 60.0% of the patients in the control group (Table 2).

Table 2

Positive Response to Treatment Group 1

(n=16)Group 2

(n=15)First Stage43.7% (7)13.3% (2)Second Stage31.3% (5)20.0% (3)Third Stage12.5% (2)26.7% (4)

The final outcome of the therapy related to the clinical forms of paralyses showed that all patients suffering of radial nerve palsy and Erb-Duchenne paralysis from the laser group were totally recovered and those with facial asymmetry cured in a proportion of 80.0%.

In the control group 50% of the patients with radial paralysis were healed completely, while 44.4% of the facial asymmetry and 25% of the Erb-Duchenne paralysis subjects did not experience a complete recovery (Table 3).

Table 3

Complete Recovery  
Group 1

(n=16)Group 2

(n=15) Facial Asymmetry80.0% (8/10)55.6% (5/9)Erb-Duchenne Paralysis100.0% (4/4)75.0% (3/4)Radial Paralysis100.0% (2/2)50.0% (1/2)TOTAL87.5% (14/16)60.0% (9/15)

The positive evolution of two patients: one diagnosed with Radial Palsy and treated with LLL is displayed in Figure 3: a – before treatment, b – after treatment, c – after 10 months from the therapeutic trial; and the other one diagnosed with Facial Asymmetry is shown in Figure 4: a – before treatment, b – after treatment.

Figure 3.

Figure 4.

Conclusions

The high efficacy rate in the regeneration of peripheral nerve injuries triggered by LLLT, especially in newborns and infants, clearly indicates the validity of this new treatment technique. More considerations could be offered regarding the future of nerve regeneration to help move this method into broader clinical applications.

References

  1. Nelson Textbook of Pediatrics (2000). (Philadelphia, W.B. Saunders Comp).
  2. Whaley, L.F., and wong, D.L. (1987). Nursing Care of Infants and Children, (St. Louis – Missouri, The C.V. Mosby Company).
  3. Singhi, S. (1980). Congenital Asymmetrical Crying Faces. Clin Pediatr. 19, 673 – 678.
  4. Karu, T. (1998). The Science of Low-Power Laser Therapy. (Amsterdam: Gordon and Breach Science Publishers).
  5. Lasers in Medicine and Dentistry: Basic science and up-to-date clinical application of Low Energy-Level Laser Therapy – LLLT, (2000). (Rijeka – Croatia, Vitagraf).
  6. Ailioaie, L.M., Ailioaie C. and Topoliceanu F. (2001). Laser Action in Nerve Injuries in Children. Book of Abstracts, 8-th International Congress of EMLA, Moscow, 42.
  7. Ailioaie C, Ailioaie LM. (2002). Low Level Laser Therapy as a Medical Treatment Modality in Pediatrics – Invited Educational Lecture. International Proceedings Division Monduzzi Editore, Proceedings of the 4th Congress of the World Association for Laser Therapy ***book***, Editor(s): Hanaoka K., Kubota J., Arita H., p. 1-6, Tokyo, Japan, ISBN: 88-323-2627-2.

*****

Lik Sprava. 1998 May;(3):130-4.

[A differentiated approach to laser puncture in facial neuritis by using the methods of acupuncture diagnosis]

[Article in Ukrainian]

Macheret IeL, Chupryna HM.

Abstract

Overall 87 patients with neuritis of the facial nerve were studied by making use of methods of acupuncture diagnosis as recommended by Nakatani and Akabane. The parameters under investigation included the level of physiologic corridor, left-right asymmetry, the Yang and the Yin meridians sum ratio, maximum deviation from the physiological corridor in certain meridians. The results obtained permitted the identification of three groups of patients depending on the duration of their illness. This permitted the differentiated approach to the use of laser puncture in these patients securing good results of treatment which were confirmed by both the positive dynamics of acupuncture methods of investigation and data supplied by the electrophysiological techniques (EMG, EEG). With the purpose of performing laser puncture, the infrared laser puncture apparatus Biomed-001 (wavelength 0.89, average laser emissive power 20 mw) was employed.

Lik Sprava. 1997 Sep-Oct;(5):172-5.

[Infrared laser puncture in the treatment of facial neuritis]

[Article in Ukrainian]

Chupryna HM.

Abstract

Overall eighty-seven patients with facial neuritis [correction of paralysis] received multimodality treatment involving infrared laser acupuncture procedures. The unit "Biomed-001" operating at wavelength 890 nm with intensity 20 mW served as a source of laser light. The acupuncture points (with 10 to 15 points in each treatment session, duration of exposure being 1 to 3 min) were selected according to principles of traditional Chinese medicine. One course of the infrared laser therapy acupuncture treatments is 12 to 16 sessions. The described treatment option applied in the above patients population was associated with a good clinical effect confirmed by results of studies made with the aid of electrophysiological modalities.

 

HELIUM-NEON LASERTHERAPY IN TREATMENT OF FACIAL NERVE NEUROPATHY

A. Scherbonosova, V.V. Skupchenko
Medical university, Far Eastern Medical Center, Khabarovsk, Russia

Facial nerve damage is the result of different factors influence and it appears at the background of ischemia anoxia. Elimination of a local pathologically fixed ergothroimages ischemia condition with the help of helium-neon laser therapy (FTNLT) has been conducted taking into consideration initial vegetative pattern of patients. It allowed to adjust treatment methods based on laser effect individually for every patient. Mimic muscles function restoration in the course of treat­ment had begun after 5 treatment sessions with HNLT and matched vegetative status normalization as well as reofaciogram, ultrasound Dopplerography of temporal and ophthalmic arteries and general conjunctive index. Thus, HNLT is a gentle corrector of vegetative homeostasis and sanogenic mechanisms. It allows to synchronize local and cerebral hemodynamics rhythms and trigger reparative re­generation of the facial nerve.