Abstract

Bell’s palsy is the most common form of idiopathic facial paralysis that we see as physicians. We report on a 43-year-old woman with a two-year history of unilateral facial palsy that had stabilized, and was unresponsive to treatment with steroids and antiviral medications. Treatment with adipose-derived mesenchymal stem cells provided a significant improvement in symptomology with thirty days. Bell’s palsy is an idiopathic facial nerve weakness or palsyof 7th cranial nerve, thought to be caused by a viral or autoimmune origin. It is the most common cause of facial paralysis, accounting for 50-75% of cases and is part of a differential diagnosis of a cerebrovascular accident. Middle age patients are most commonly affected by the disease process, and it affect both males and females with an equal predilection. Resolution often begins within two weeks, and continues for up to six months. Many, if not most,resolve spontaneously. However, it is not uncommon to see patients
with relentless symptoms for 2-3 years extending to 7-10 years. Comorbid factors contribute to the likelihood of onset, and includepregnancy, diabetes, hypertension, Guillain-Barré syndrome,multiple sclerosis, Lyme Disease and myasthenia gravis, to name a few.

Introduction

The facial nerve originates from the motor nucleus of the pons. Entering the internal acoustic meatus in the petrous portion of the temporal bone. An arachnoid-lined dura mater sheath encases the nerve, exiting through the stylomastoid foramen. The extracranial distal fivebranches innervate the face distal to the stylomastoid foramen. The intracranial branches provide special sensation to the anterior 2/3 of the tongue, and parasympathetic innervation to the stapedius, the salivary glands, the sinuses, the nose, the palatine nerves and the lacrimal gland amongst others. Thus, paralysis can involve multiple systems of the facial anatomy. There is drooping of the corner of the mouth, inability to close the affected eye, dry eye or epiphora, drooling, sensitivity to sound, pain of the face or behind the ear, inability to taste food and facial tingling.

There are changes of appearance, but the functional abnormalities are usually more debilitating. The facial nerve’s anatomical course has led some to believe that the nerve interacts with other anatomical structures along its path through the bone and soft tissue [1]. Specifically, the nerve is adjacent to the meninges and can develop entrapment neuropathies that can find relief with chiropractic manipulation and treatment [2].

The trapezius and sternomastoid muscles are supplied by the spinal accessory nerve and are capable of contributing to a Bell’s palsy by the proximity of the nuclei of the trigeminal, accessory and facial nerves. Traditional treatment involves antiviral medications within three days of onset, and oral steroids. The immunosuppressive aspect of steroids in this inflammatory process may be the key to resolving the symptomology. Sadly, many times patients are told that they have to learn to live with the symptomlogy. There are reports in the literature of acupuncture utilized within three days of symptom onset, relieving the effects of the palsy or completely curing 100 of 684 cases of facial nerve paralysis[3]. Traditional Chinese medicine oftener commends herbal treatments to supplement and treat facialpalsy[4]. Rubis reported in 2013 that she performed low level laser treatment for Bell’s palsy using a Gallium arsenide (GaAs) class 4 laser with a wavelength of 910 nm[5]. An improvement she reports were 70-80% after the first treatment. The use of laser treatment for nerve injury has been reported in the literature with successful results[6,7]. We report a case where adipose derived stem cells were used for precisely this purpose.

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