Psychological Factors Are Closely Associated with the Bell’s Palsy: A Case-control Study

To observe the differences in psychological status between Bell’s palsy (BP) patients and healthy subjects, and to examine the relationship between psychological factors and the severity of BP, we conducted a case-control, multi-center clinical investigation. A total of 695 subjects were as-signed to the case group (n=355) and the control group (n=340). House-Brackmann grading system and Facial Disability Index (FDI) were adopted to assess the BP patients; Kessler Psychological Dis-tress Scale (K10) and 16 Personality Factor (16PF) scale were employed to evaluate the psychologi-cal distress and personality profiles of all subjects. Two independent samples t test was used to com-pare the differences between cases and controls, and to compare the differences among different BP patients. Pearson correlation analysis was used to examine the relationship between psychological factors and severity of facial paralysis. The results showed that psychological distress (K10) in case group (27.09±5.80) was significantly higher than that in control group (13.43±3.02) (t=-37.219, P=0.000). The scores of personality factor Warmth (A), Openness to Change (Q1), Self-Reliance (Q2) were lower in cases than in the controls (P<0.01, P<0.05, P<0.05, respectively), whereas the scores of Sensitivity (I), Vigilance (L), Apprehension (O), and Tension (Q4) were significantly higher in cases than in the controls (P<0.05, P<0.01, P<0.01, P<0.01, respectively). In addition, the psy-chological distress was significantly higher in female patients, severe (HB score Ⅳ-Ⅵ) patients, and subacute (onset time 72-168 h) patients compared with that in male patients, mild (HB score Ⅰ-Ⅲ)patients, and acute (onset time≤72 h) patients (P<0.05). The scores of personality factor in fe-male patients, severe patients, and subacute patients were also significantly different from male pa-tients, mild patients, and acute patients (P<0.05). The result of Pearson correlation analysis showed that psychological factors (K10, personality A, F, L, N, O, Q4) were closely related to HB scores. We are led to conclude that the psychological status between BP patients and healthy people are different; psychological distress and personality factors are closely associated with severity of facial paralysis.     

中西医结合治疗急性Bell麻痹的前瞻性队列研究

目的观察Bell麻痹最佳组织疗法和措施,探索急性Bell麻痹治疗方法的选择、疗效和后遗症的关系。方法使用前瞻性队列研究将150例患者分为观察组(50例)、对照组1(50例)和对照组2(50例)。观察组采用针刺加中药饮片面瘫祛风复正汤(牵正散加减)内服结合西医疗法。对照组1采取纯中医疗法(针刺、面瘫祛风复正汤),对照组2采取纯西医疗法。10 d为1个疗程,三组均治疗至少3个疗程和至少观察3个月。采用面神经功能分级(HB分级)量表、面部残疾指数(FDI)评分量表等指标,分别于治疗前和治疗后第1、2、3个疗程和第2、3个月进行评价。结果治疗1-3个月后,三组均可降低HB分级,提高FDI评分,差异有统计学意义(P<0.01),且治疗后观察组FDIP和FDIS评分优于2个对照组,差异有统计学意义(P<0.05);观察组疗效明显优于2个对照组,差异有统计学意义(P<0.05);观察组治愈率92%(46/50),优于对照组1的76%(38/50)和对照组2的72%(36/50),差异有统计学意义(P<0.05);治疗3个月后,观察组后遗症发生率为4%(2/50),低于对照组1的20%和对照组2的24%,差异均有统计学意义(P<0.05);观察组痊愈患者的平均治疗时间(24.65±9.95)d,少于对照组1的(33.46±11.35)d、对照组2的(35.76±12.46)d,差异均有统计学意义(P<0.01)。结论中西医结合治疗急性Bell麻痹疗效明显优于单纯中医组和单纯西医组,且后遗症发生率低于2个对照组。     

中西医结合治疗Bell面瘫的临床疗效观察

目的：评价以牵正散加减配合针灸的中西医结合方法治疗Bell面瘫的临床疗效。方法：选择急性期患者50例随机分为两组,对照组采用西医常规治疗方法,治疗组在常规治疗基础上应用牵正散加减,并配合针灸治疗,治疗1个疗程,对两组患者治疗前后的病情予以评分及分级。结果：治疗后治疗组总有效率为100%,对照组总有效率为80%,两组比较有差异有统计学意义（P<0.05）。治疗组疗效优于对照组。结论：以中药牵正散加减,并配合针灸的中西结合治疗是贝尔面瘫的优先治疗方法。     

Evaluation of Endoscopic Iliopsoas Tenotomy for Treatment of Iliopsoas Impingement After Total Hip Arthroplasty

BackgroundIliopsoas impingement after total hip arthroplasty (THA) occurs in up to 4.3% of patients resulting in functional groin pain. Operative treatment historically has included open iliopsoas tenotomy or acetabulum revision. We present a large single surgeon series of patients treated with endoscopic iliopsoas tenotomy for iliopsoas impingement after THA to evaluate the effectiveness and risks.MethodsA consecutive series of 60 patients with iliopsoas impingement after THA treated with endoscopic iliopsoas tenotomy was retrospectively evaluated. Outcomes assessed were resolution of pain, change in Hip Outcome Score (HOS), and complications. Radiographs were reviewed by a musculoskeletal radiologist to evaluate component positioning and to compare with a control cohort.ResultsAt last follow-up (mean 5.5 months), 93.3% of patients had resolution of pain. The HOS activities of daily living (ADL) subscale mean was 57.5 (range 10.9-89.3, standard deviation [SD] 18.8) preoperatively and 71.6 (range 14.1-100, SD 26.1) postoperatively (P = .005). The HOS sports subscale mean was 37.3 (range 0-83.3, SD 24.0) preoperatively and 58.1 (range 0-100, SD 33.2) postoperatively (P = .002). One complication was reported, a postoperative hematoma managed conservatively. Body mass index and increased offset were associated with iliopsoas symptoms after THA in this series.ConclusionEndoscopic iliopsoas tenotomy after THA had a 93.3% resolution of pain, clinically important improvements in HOS, and low rate of complications. Endoscopic tenotomy should be considered as a treatment option in patients with iliopsoas impingement after THA.     

Wound healing after anterior and posterior subapical osteotomy

Changes in the process of wound healing and in the dental pulp were examined following anterior and posterior mandibular subapical osteotomies in pig-tailed macaque monkeys. Results of microangiographic and histologic investigations indicated that degenerative pulpal changes may occur following mobilization and repositioning of small dentoalveolar segments. The potential significance of such degenerative pulpal changes and the need for routine dental radiographic checkups following anterior and posterior mandibular dentoalveolar surgery are discussed.     

Bell’s palsy in a pediatric patient with hyper IgM syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Bell’s palsy is an acute facial paralysis with known association to viral infections. We describe a medically complex 6-year-old male with hyper IgM syndrome who presented with unilateral facial droop and positive SARS-CoV-2 RT-PCR. This is the first reported pediatric case of Bell’s palsy in the setting of SARS-CoV-2 infection.     

A systematic review of Bell’s Palsy as the only major neurological manifestation in COVID-19 patients

BackgroundBell’s palsy is an acute idiopathic paralysis of the facial nerve. The disease is caused by many viruses like Herpes simplex virus-1, Varicella zoster, Epstein-bar virus, Cytomegalovirus, Usutu virus, Human immunodeficiency virus, etc. Literature has reported few cases of COVID-19 patients with Bell’s palsy as the only major neurological manifestation indicating the possible role of another virus in the etiopathogenesis of Bell’s Palsy. This paper aims to evaluate the reported cases of COVID-19 positive patients, presented with Bell’s palsy as the only major neurological manifestation from March 2020 to December 2020, and to investigate the association of SARS-CoV2 and Bell’s palsy.Materials and methodsA systematic review of the published literature was performed using an electronic search in PubMed/Medline, Science Direct, Web of Science, Embase, J- STAGE, Google Scholar, China National Knowledge Infrastructure (CKNI) and Scopus databases, from March 2020 to Dec 2020 using keywords like ‘COVID-19’, ‘SARS-CoV-2’, ‘Coronavirus’, ‘Bell’s palsy’, ‘Facial nerve’, ‘First’, ‘Only’,‘ Neurological’, ‘Manifestation’. The studies reviewed were case series and case reports regarding the subject.ResultsSearch strategy revealed thirteen articles from March 2020 to Dec 2020 with a total of 20 cases of COVID-19 with Bell’s palsy as the only major neurological manifestation.ConclusionEvidence of Bell’s palsy as the only major neurological manifestation in COVID-19 patients signifies an important clinical finding but robust research is needed to investigate their association and the exact mechanisms by which SARS-CoV2 causes Bell’s Palsy.     

王寅教授针刺治疗贝尔面瘫经验撷要

介绍王寅教授对针灸治疗贝尔面瘫的独到经验,其主张针前先闪罐以活血通络、祛风扶正,根据贝尔面瘫各期病症特点的不同进行分期治疗,基于贝尔面瘫的病位特点提倡早期针刺治疗,并注重针刺手法宜轻巧,最后强调功能锻炼。王师如此系统的疗法,收到了较好的临床疗效。