Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

BACKGROUND   Bell’s palsy, also called facial nerve palsy, occasionally   co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.

CASE REPORT   A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.

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CONDITIONS Section

CONCLUSIONS   This case illustrates improvement of Bell’s palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell’s palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell’s palsy.

Keywords:   Bell Palsy, Chiropractic, Manipulation, Spinal, Musculoskeletal Manipulations, Neck Pain, Trigeminal Nerve Diseases

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Background

Bell’s palsy, also called cranial nerve VII or facial nerve palsy, is a sudden-onset facial weakness with several potential triggers. Co-occurrence of facial nerve palsy with another cranial neuropathy, termed cranial polyneuritis, may be relatively common, with the trigeminal nerve potentially being the most common comorbid cranial neuropathy. [1] While cranial nerve VII is predominantly a motor nerve, co-involvement of the trigeminal nerve, which has a broad sensory distribution, may lead to pain and/or sensory deficits. [1–3]

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