Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review
Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen
New Chiropractic and Physiotherapy Centre,
Kowloon, Hong Kong.
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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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
From the Full-Text Article:
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.  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]