Xiaoxuming Decoction is an ancient classic herbal formula for the treatment of stroke. In ancient times, the connotation of stroke was very extensive, including facial neuritis, acute cerebral infarction, acute cerebral hemorrhage, sequelae of cerebral hemorrhage, unexplained weakness of limbs, cervical spondylosis, acute myelitis, acute radiculitis, Guillain Barre syndrome, multiple sclerosis, myasthenia gravis, motor neuron disease, dermatomyositis, hypokalemic paralysis peripheral neuritis. It has been identified that: ①Xiaoxuming Decoction is very common in the treatment of cerebrovascular diseases, such as cerebral infarction, cerebral hemorrhage and other cerebrovascular diseases, facial neuritis, acute myelitis, acute radiculitis, Guillain Barre syndrome, unexplained limb weakness, multiple sclerosis, motor neuron disease, myasthenia gravis, and rheumatic and immune system diseases, such as dermatomyositis, and can not only alleviate symptoms, but also improve prognosis and the long-term survival rate. ②Sudden limb failure, facial paralysis, and hypoalgesia without heat syndrome are the key indications of Xiaoxuming Decoction. ③This is a special prescription for the treatment of acute facial neuritis, and can cure in one week in the combination with moxibustion. ④In the treatment of facial neuritis complicated with hypertension or acute cerebrovascular disease, Xiaoxuming Decoction generally has a certain antihypertensive effect, without any hypertensive effect, which reflected its two-way regulatory effect for blood pressure. ⑤In the treatment of unknown limb weakness, acute myelitis, acute radiculitis, Guillain Barre syndrome, Xiaoxuming Decoction can rapidly alleviate the symptoms. ⑥This is the basic formula for multiple sclerosis and motor neuron disease. Long term use of Xiaoxuming Decoction can alleviate the symptom of limb weakness, reduce the occurrence of complications and delay the progress of the disease, but with a poor long-term prognosis. ⑦In the treatment of myasthenia gravis, Xiaoxuming Decoction can significantly improve muscle strength, and gradually help stop hormone reduction. After thymoma surgery, Xiaoxuming Decoction is also applicable to some patients with recurrent myasthenia gravis. ⑧Xiaoxuming Decoction also plays a role in the treatment of dermatomyositis and cervical spondylopathy. ⑨Raw ephedra is the monarch drug of Xiaoxuming Decoction, which is the key to the effect. The dosage starts with 6 g is titrated in a small dose and increases gradually. In addition, this formula is forbidden for those with red face, fast heart rate, high blood pressure, blocked stool, red tongue, yellow fur, wiry and rapid pulse or powerful pulse, and spout pulse.
Dermatomyositis ; Facial Nerve Diseases ; Guillain-Barre Syndrome ; Humans ; Motor Neuron Disease ; Multiple Sclerosis ; Myasthenia Gravis ; Myelitis ; Radiculopathy ; Spondylosis

OBJECTIVE: To observe the effect of different acupuncture intervention time on the improvement of the symptoms of acute facial neuritis and the length of recovery time, and to find the best interventional opportunity for acute facial neuritis. METHODS: A total of 120 patients with acute facial neuritis (all unilateral onset) were randomly divided into 4 groups, namely group A, group B, group C and group D, 30 cases in each group. Acupuncture performed within 3 days after onset in the group A; oral mecobalamin dispersible tablets and multivitamin B tablets were received within 3 days after onset, and acupuncture was started from the 4th day in the group B; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 5 days after onset, and acupuncture was administered from the 6th day in the group C; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 7 days after onset, and acupuncture was applied from the 8th day in the group D. Penetration needling was the main acupuncture treatment, with infrared radiation on the cheeks, once a day, 6 days a week and 3 weeks were given. After treatment, the symptom scores (Portmann scores) of the 7th, 14th and 28th day after onset were compared. The time of improvement and the clinical effect of each group were compared. RESULTS: On the 7th, 14th and 28th day after onset, the Portmann scores of the 4 groups were higher than those before treatment (all <0.05). On the 7th, 14th and 28th day after onset, the Portmann scores in the group A were higher than those in the other 3 groups (all <0.05). There was significant difference between both pairs of group B, group C and group D (all <0.05). The total effective rate in the group A was 96.7% (29/30), which was higher than 93.3% (28/30), 86.7% (26/30) and 83.3% (25/30) in the other 3 groups (all <0.05). The difference between the 4 groups in the beginning of improvement, significant improvement time and clinical recovery time was statistically significant (all <0.05), and the group A was optimal. CONCLUSION Early intervention of acupuncture with acute facial neuritis can appropriately slow the progression of facial nerve injury, improve the therapeutic effect, and shorten the clinical recovery time.
Acupuncture Therapy ; Combined Modality Therapy ; Facial Nerve Diseases ; therapy ; Humans

PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.
Bell Palsy ; Brain Neoplasms ; Cerebrovascular Disorders ; Cranial Nerve Diseases ; Cranial Nerves ; Epithelium, Corneal ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Strabismus ; Tears

Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
Cell Body ; Cervical Cord ; Demyelinating Diseases ; Facial Pain ; Head ; Humans ; Neck ; Odontoid Process ; Pons ; Spinal Cord ; Spinal Injuries ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia

Ramsay-Hunt syndrome is an infectious disease caused by the varicella zoster virus. It is usually associated with facial and vestibulocochlear nerve palsy, but other cranial nerve dysfunction can be accompanied. We present a 68-year-old woman with abducens nerve palsy associated with Ramsay-Hunt syndrome. She showed abduction limitation of left eye with peripheral facial palsy and vestibulopathy of the left side. Varicella zoster virus polymerase chain reaction of cerebrospinal fluid was positive and internal auditory canal magnetic resonance imaging was revealed enhancement of labyrinthine segment of left facial nerve. Although abducens nerve palsy is uncommon feature of Ramsay-Hunt syndrome, but it can be developed by several different mechanisms.
Abducens Nerve Diseases ; Abducens Nerve ; Aged ; Cerebrospinal Fluid ; Communicable Diseases ; Cranial Nerves ; Facial Nerve ; Facial Paralysis ; Female ; Herpesvirus 3, Human ; Humans ; Magnetic Resonance Imaging ; Paralysis ; Polymerase Chain Reaction ; Vestibulocochlear Nerve

BACKGROUND: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. CASE REPORT: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. CONCLUSION: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.
Cranial Nerve Diseases ; Cranial Nerves ; Deglutition Disorders ; Dizziness ; Ear ; Facial Paralysis ; Head ; Hearing Loss ; Herpes Zoster Oticus ; Herpes Zoster ; Herpesvirus 3, Human ; Hiccup ; Hoarseness ; Humans ; Laryngitis ; Larynx ; Middle Aged ; Neck ; Paralysis ; Pharynx ; Polymerase Chain Reaction ; Saliva

Bell's palsy is an acute-onset unilateral peripheral facial neuropathy. For patients with sequelae of facial paresis, the successful rehabilitation of fully edentulous arches is challenging. This case report described the treatment procedures and clinical considerations to fabricate complete dentures of a patient who showed unilateral displacement of mandible, unilateral chewing pattern and parafunctional jaw movement due to sequelae of Bell's palsy. Gothic arch tracing was used to record reproducible centric relation and lingualized occlusion was performed to provide freedom to move between centric relation and the patient's habitual functional area in fabricating satisfactory dentures in terms of function and esthetics.
Bell Palsy ; Centric Relation ; Denture, Complete* ; Dentures ; Esthetics ; Facial Nerve Diseases ; Facial Nerve* ; Facial Paralysis ; Freedom ; Humans ; Jaw ; Mandible ; Mastication ; Paralysis* ; Rehabilitation*

OBJECTIVES: The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model. METHODS: The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals. RESULTS: In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P < 0.05). CONCLUSION: Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.
Action Potentials ; Animals ; Axons ; Cell Proliferation ; Demyelinating Diseases ; Facial Nerve Injuries ; Facial Nerve* ; Insulin* ; Insulin-Like Growth Factor I ; Models, Animal ; Myelin Sheath ; Rabbits ; Schwann Cells ; Sodium Chloride

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.
Arteriovenous Fistula ; Arteriovenous Malformations ; Cranial Nerve Diseases* ; Cranial Nerves* ; Edema ; Facial Nerve ; Humans ; Paralysis ; Steroids ; Traction ; Trigeminal Neuralgia ; Vasa Nervorum ; Vascular Malformations*

A 25-years-old woman with mandibular prognathism underwent a mandibular setback by way of mandibular sagittal split ramus osteotomy (MSSRO). After 2 days of operation, she developed difficulty of closing her right eye. The blink reflex test and motor nerve conduction study of the right orbicularis oris muscle were revealed right facial neuropathy of unknown origin and House-Brackmann facial nerve grading system (HBFNGS) grade V. For treatment, we initially prescribed oral prednisolone and nimodipine including physical therapy. The samples consisted of 11 facial nerve palsy patients caused by MSSRO and were analysed about onset of facial nerve palsy, postoperative HBFNGS, final HBFNGS, treatment method and recovery time. At 10 weeks of treatment of nimodipine, she had completely regained normal function (HBFNGS grade I) of the right facial nerve. The clinical results lead to assume a fast recovery of facial nerve function by the nimodipine medication, whereas average time of recovery is 16.32 weeks in references. Despite of the limited one patient treated, the result was very promising with respect to a faster recovery of the facial nerve function. Considering the use of nimodipine treatment for peripheral facial nerve palsy following a surgical approach with an anatomically preserved nerve can be recommended.
Blinking ; Facial Nerve Diseases ; Facial Nerve* ; Facial Paralysis ; Female ; Humans ; Mandible* ; Methods ; Neural Conduction ; Nimodipine ; Osteotomy, Sagittal Split Ramus* ; Paralysis* ; Prednisolone ; Prognathism