Objectives: To demonstrate the effect of acupuncture in a child with chronic Bell's palsy of 7 years duration.
Subject: A 15-year-old girl had Bell's palsy for 7 years and did not respond to steroid treatment in the acute phase. On examination, her eyes were asymmetric, with the right eye smaller. Muscle contracture was noted around the right nasalis. She had synkinesis (i.e., when she blinked, there was involuntary twitching of her mouth at the right side). She showed marked facial distortion when puffing out cheeks, smiling, and raising her eyebrows. The tip of her tongue was swollen with red spikes. House-Brackmann facial nerve grading system (HBS) before treatment was grade 4.
Treatment: Patient was given 25 acupuncture treatment sessions in 2 months. Local acupuncture points used were: LI20, ST2, ST3, ST4, ST6, ST7, SI18, BL2, TE17, TE23, GB14, GV26, CV24, EX-HN5, and EX-HN16; distant points used were: LI11, ST36, ST40, SP6, SP10, HT8, SI3, BL67, PC8, TE5, and LR3. About 10 points were selected from the above set in each session with needles inserted to elicit the de qi response. The patient was asked to report any change in muscle strength or any differences noted after each acupuncture session. Photographs and videos were taken for blind assessors to comment on.
Result: The patient rated an overall improvement of 60-70%. Self-perceived muscle strength when smiling and puffing out cheeks increased from 20% of normal strength to 65%, and the strength when raising eyebrows increased from 10% to 70%. Synkinesis was attenuated. Photographs and videos showed improvement in facial asymmetry. HBS changed to grade 3 after treatment.
Conclusions: Our study showed that acupuncture can be effective in improving functional and cosmetic outcome even for chronic Bell's palsy.