Acupuncture therapy in the late recovery phase of facial nerve neuropathy

BACKGROUND: In 10%–30% of patients, the clinical course of facial nerve neuropathy progresses to a chronic stage with only partial recovery of facial muscle function and development of complications, including synkinesis and contractures. Current treatment approaches remain insufficiently effective.

AIM: To examine the clinical characteristics of facial nerve neuropathy during the late recovery period, select reflexotherapy-based treatment approaches, and assess treatment outcomes.

METHODS: Thirty-four patients aged 19–80 years (mean age: 49.9 ± 12.1 years) with facial nerve neuropathy (15 men and 19 women) were examined. Patients were divided into three groups according to clinical features: group 1 (22 individuals) with compression–ischemic neuropathy; group 2 (6 individuals) with infection-mediated neuropathy; group 3 (6 individuals) with history of traumatic facial nerve injury. All patients underwent clinical and instrumental evaluation using the House–Brackmann Facial Nerve Grading Scale, the Sunnybrook Facial Grading System for assessment of severity of paresis and pathological synkinesis, and electroneuromyography. Combined treatment included a course of acupuncture with a 4-month follow-up period.

RESULTS: Based on clinical neurological examination, postneuritic contractures and synkinesis were identified in all patients. Electroneuromyography demonstrated mixed severe nerve fiber damage. The Sunnybrook Facial Grading System was the most appropriate scale for assessing the trends of contractures and synkinesis. Acupuncture demonstrated clinical value for rehabilitation of patients with long-term consequences of facial nerve neuropathy. Its use enables influence on neuroplasticity processes. The reflexology method of proprioceptive stimulation developed by Shishkina enables modulation of pathological cortical processes and provides positive changes in the treatment of complications during late recovery of facial nerve neuropathy. Correction of facial nerve neuropathy complications such as contractures and synkinesis requires long-term treatment and repeated acupuncture courses.

CONCLUSION: Acupuncture combined with physical rehabilitation methods is an effective approach to treating complications of facial nerve neuropathy. Therapeutic exercises focused on muscle relaxation and stretching alone are not always sufficient to improve facial symmetry. Acupuncture within combination therapy allows achieving a sustained, significant clinical effect in correcting moderate and severe complications (muscle hypertonia and synkinesis).