背景贝尔麻痹,也叫面神经麻痹,偶尔会合并三叉神经病变,表现为额外的面部感觉症状和/或颈部疼痛。贝尔氏麻痹有一种病毒病因学,特别是在牙科操作后发生时。病例报告一名52岁的亚洲女性出现在一名脊椎按摩师那里,有3年的持续颈部疼痛和左侧上颌,眉毛,颞下颌面部疼痛,麻痹,和感觉异常,这是在使用牙签后开始的,可能导致牙龈损伤.她以前接受过抗病毒药物和泼尼松治疗,中草药,和针灸,但一年后她的恢复稳定在60%。按摩师订购的颈椎磁共振成像,证明了颈椎病,没有脊髓病或主要病理的证据。治疗包括颈椎和胸椎手法,颈椎牵引,软组织疗法,颈部锻炼。患者反应积极。在1个月的随访中,面部和颈部疼痛和面部轻瘫的解决除了残余眼睑运动。文献综述确定了另外12例,据报道,脊柱整脊手法与多模式疗法可改善贝尔麻痹。包括目前的情况,这些患者中有85%的面部或颈部也有疼痛。结论本病例说明采用包括脊柱推拿在内的多模式整脊治疗可改善贝尔麻痹和并发三叉神经病变。其他类似病例的有限证据表明,三叉神经通路在贝尔麻痹并发面/颈部疼痛的这些积极治疗反应中的作用。应该通过研究设计来探索这些发现,以解释贝尔麻痹的自然史。
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. 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.