Introduction to Bell's palsy
Believed to be caused by inflammation of the facial nerve (7th cranial nerve), the paralysis results in distortion of the face and interferes with normal functions such as eating, smiling and closing the eyes. The progress from onset of symptoms to maximal weakness usually occurs within three days and almost always within one week. A thorough history of the onset and progress of paralysis is important as history of a gradual onset of more than two weeks' duration is suggestive of a mass lesion.
Bell's palsy has been documented in patients of all ages, with peak incidence observed in the 40s. The annual rate of occurrence of Bell's palsy is about 20 per 100,000 population and the rate increases with age. In the United States around 40,000 people are affected with Bell’s palsy every year. It is seen commonly in pregnant women and patients with diabetes. Complications of Bell's palsy range from incomplete eyelid closure to long-term complication such as permanent facial weakness with muscle contractures. Conventional treatments consist of various medications and/or surgery. Various studies have suggested that acupuncture is beneficial for facial palsy to relieve the symptoms and restore the appearance of the patient. The outcome for individuals affected with Bell's palsy is generally very good. About sixty to eighty percent of cases recover completely within a few weeks to months with or without treatment.
Clinical Presentation of Bell's palsy
The typical clinical features of Bell's palsy are weakness or complete paralysis of all the muscles on one side of the face. The following are the common features seen in affected patients:
- Disappearance of facial creases and nasolabial fold
- Drooping of saliva from the corner of the mouth
- Sagging of the lower eyelids and inability to close the eyelids; when patient tries to close the eye, there’s upward rolling movement of the eye (Bell's phenomenon)
- Eye irritation due to lack of lubrication
- Reduced tear production, however, the eye may appear to tear excessively due to loss of eyelid control
- Impaired speech
- Pain around the jaw or behind the ear on the affected side
- Increased sensitivity to sound on the affected side
Complications of Bell's palsy
- Abnormal facial movement and tear and salivation at inappropriate time and creating embarrassing situation
- Permanent disfigurement of face
- Damage and infection of eye
Diagnose of Bell's palsy
Though there are many features associated with Bell's palsy, there is no exactly known etiology. Its diagnosis is essentially a diagnosed by elimination. One needs to carefully rule out the possibilities of other conditions with similar presentations.
Treatment of Bell's palsy
Treatment may be unnecessary in the patients with incomplete facial palsy, because there are good chances of recovery without intervention. In the patients with complete paralysis early treatment with steroids is effective. Antivirals drugs such as acyclovir are also used, but their results are not very encouraging. Surgical treatment to decompress the facial nerve may also be attempted but the benefits are not certain. Acupuncture may also be tries alone or in combination with other therapies for Bell’s palsy.
Acupuncture as a Treatment
In conventional Chinese medicine, Bell's palsy is known as Zhong Feng which translates as “Wind Attack”. This condition was thought to be associated with an invasion of “wind” that causes an imbalance in the “Qi”, which is the essential substance of the body, and stagnation of blood. The principle of acupuncture treatment is to expel this wind and enhance the movement of Qi and blood circulation. A number of Chinese studies had supported the therapeutic effect of acupuncture which was found to be beneficial in the management of Bell's palsy. Reports had shown a minimum cure rate of 37 percent and a highest cure rate of 100 percent, with an average of 81 percent.
Acupuncture is often very successful in relieving the facial paralysis especially when treatment is begun within the first two weeks of diagnosis. This form of treatment uses natural pressure points on the body and is believed to relieve pain by limiting swelling and inflammation. The acupuncturist inserts small, thin needles into the skin in a number of main pulse points throughout the face and body. Some of the key point insertions will be in the stomach, liver, gall bladder, spleen, large intestine, forehead and hands. The side of the face that is used varies from patient to patient. There is no harmful side effect to this treatment.
Read More: Bell's Palsy: Cranial Nerve Dysfunction
After the Acupuncture Bell's palsy
After the needles have been removed, cupping (a form of therapy used to increase circulation) is used to remove wind and activate the local blood circulation. This procedure is usually followed for five times per week depending upon the severity of the cases. It is necessary to follow the recommended dietary and stress reduction advices given after the initiation of acupuncture treatment. The patient should drink more water and avoid alcohol and sugary items.
Patients with Bell's palsy who receive treatment within the first two weeks will experience restored circulation, increased muscle function and reduced numbness as early as after six to eight visits. Some studies suggest that Bell's palsy patients respond better to acupuncture treatment when it is combined with herbal therapy. Therefore, Chinese herbal medicines can be taken during the course of the treatment. These herbs are believed to have three basic functions; to kill the harmful virus, strengthen the body and promote a balanced internal system. These herbal medicines usually have low risk of side effects, especially when prescribed and prepared by a trained acupuncturist.
Recently there have been some studies on the effect of acupuncture on Ball’s palsy. Though some or the other beneficial effects were shown in the studies, further studies with better design and reporting are required to arrive at any conclusion about the efficacy of acupuncture.
There is no known way of prevention of the disease, but once the disease is developed, eyes should be protected to prevent infection and injuries.