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EVE Facialnerveparalysis Eve.12042
EVE Facialnerveparalysis Eve.12042
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Case Report
Multimodal therapy including electroacupuncture for the treatment
of facial nerve paralysis in a horse
C. de Fourmestraux*, C. Tessier and G. Touzot-Jourde
Surgery Department, Equine Clinic, ONIRIS, Nantes-Atlantique, National College of Veterinary Medicine, Food
Science and Engineering, Nantes, France.
*Corresponding author email: claire.de-fourmestraux@oniris-nantes.fr
Keywords: horse; anaesthesia; facial nerve paralysis; electrostimulation
a) b)
Fig 1a) and b): The horse with distal facial nerve palsy associated with a marked muzzle deviation towards the right side and the lower lip
on the left side hung loosely.
Facial nerve
Dorsal buccal
branch
Ventral buccal
branch
3
1 Zygomaticus
Levator
nasolabialis
Levator 5
labii 4
7 Buccinator
superioris
Caninus
6 Depressor labii
2 inferioris
Orbicularis
oris
Fig 2: Superficial structures of the head; the course of the facial nerve and muscles supplied by its buccal branches.
bwt and local application twice a day of a topical gel for 2 weeks (1 week of box rest and 1 week in the paddock),
containing dimethyl sulfoxide and prednisolone. The horse and to return for follow-up.
was discharged on post operative Day 2. The owner was The horse was re-examined 2 weeks after the surgery for a
instructed to administer a 5-day course of phenylbutazone post operative evaluation of the upper airway and the facial
(Equipalazone)4 at 2.2 mg/kg bwt per os s.i.d., to rest the horse paralysis. The left partial facial paralysis was still present and a
ST4, Di Cang Stomach meridian Caudal to the corner of the mouth, at the ‘V’ junction of the levator nasolabialis
m. and zygomaticus m., on the outer margin of the orbicularis muscle.
ST6, Jiache Stomach meridian In the centre of the masseter muscle belly, just dorsal to the ventrolateral aspect
of the jaw. Located in a depression when the jaw is opened (where the ring
halter is).
ST7, Xia Guan Stomach meridian At the temporo-mandibular joint, ventral to the zygomatic arch, caudodorsal to
the lateral canthus, in the masseter m.
TH17, Yi Feng Triple heater Posterior to the ear in depression between the mandible and mastoid process.
recovery and muscle atrophy seems to be in favour of of the treatment was the most efficacious, although the
neurotmesis. Rapid recovery of nerve conduction as identified treatment success was assumed to be due to the combined
by muscle contraction elicited by stimulation of the nerve on therapy (electroacupuncture and physical therapy) after
the third treatment probably indicates a less severe lesion than initial medical treatment failed. Finally, it is important to keep in
initially assessed. Electroacupuncture treatment is believed to mind that facial paralysis might occur even after a short lateral
have been beneficial in this case as observed by the recovery recumbency and halters should be always removed when
and improvement of clinical signs over time. No improvement possible. Discussion about appropriate positioning and
was seen during the first 2 weeks with the initial medical padding to avoid nerve lesion is the primary way to avoid
treatment and facial muscle atrophy had begun. Gradual facial paralysis in horses undergoing general anaesthesia.
recovery of function over the 3-week electroacupuncture
course suggests that it is a favourable treatment. Sumano et al.
(1997) reported successful outcomes with a similar treatment
Authors’ declaration of interests
course: first stimulation within the 10 days (2 weeks for this case) No conflicts of interest have been declared.
following paralysis onset with a mean of 13 (7–17) treatments
done every other day over a course of 3–4 weeks (11 sessions Manufacturers’ addresses
over 3 weeks for the present case). Progressive improvements 1Roche, Boulogne-Billancourt, France.
were seen over the course of the treatment and very visible 2Merial, Lyon, France.
after the first or second treatment as in the present 3Boehringer Ingelheim, Paris, France.
case. Although the factors involved in the decision of 4MSD, Courbevoie, France.
treatment termination are not clearly stated, owner 5ITO, Tokyo, Japan.
satisfaction seemed to have played an important role. 6Seirin Corporation, Shizuoka, Japan.
Conclusions Delahunta, A. and Glass, E. (2009) Lower motor neuron: general somatic
efferent, cranial nerve. In: Veterinary Neuroanatomy and Clinical
Distal facial paralysis in the horse as described in the present Neurology, Eds: A. Delahunta, E. Glass and M. Kent, W.B. Saunders,
case affects food prehension ability and nostril dilation. It can St Louis. pp 134-167.
result in dysphagia and inability to perform. Spontaneous Ding, Y., Yan, Q., Ruan, J.W., Zhang, Y.Q., Li, W.J., Zhang, Y.J., Li, Y., Dong,
recovery can be long and incomplete, jeopardising H. and Zeng, Y.S. (2009) Electro-acupuncture promotes survival,
an athletic career. The use of electrotherapy seems differentiation of the bone marrow mesenchymal stem cells as well
as functional recovery in the spinal cord-transected rats. BMC
advantageous in promoting recovery and may hasten time of Neurosci. 10, 1-13.
recovery. However, as the amount of nerve injury was not
Dong, H.G. and Xie, Z.F. (2002) Acupuncture: review and analysis of
assessed before treatment and a multimodal therapeutic reports on controlled clinical trials. World Health Organisation,
approach was used, it is not possible to determine which part Geneva.
Fleming, P. (2001) Acupuncture for musculoskeletal and neurologic Shi, X., Yu, G. and He, D. (2000) An experimental study on physiotherapy
conditions in the horse. In: Veterinary Acupuncture: Ancient Art to for traumatic facial nerve injury. Zhonghua Kou Qiang Yi Xue Za Zhi
Modern Medicine, Ed: A.M. Schoen, Mosby, St Louis. pp 443-465. 35, 450-452.
Hoang, N.S., Sar, C., Valmier, J., Sieso, V. and Scamps, F. (2012) Smith, M.O. and George, L.W. (2009) Diseases of the nervous system.
Electro-acupuncture on functional peripheral nerve regeneration in In: Large Animal Internal Medicine, 4th edn., Ed: B.P. Smith, Mosby,
mice: a behavioural study. BMC Complement. Altern. Med. 12, 1-9. St Louis. pp 972-1111.
Jeong, S.M., Kim, H.-Y., Lee, C.-H., Kweon, O.K. and Tam, T.C. (2001) Use Sumano, H., Mateos, G. and Hoyos, L. (1997) The use of
of acupuncture for the treatment of idiopathic facial nerve paralysis electroacupuncture for the management of unilateral traumatic
in a dog. Vet. Rec. 148, 632-633. facial paralysis in the horse: preliminary report. Am. J. Acupunct. 25,
169-174.
Kim, M.S. and Xie, H. (2009) Use of electroacupuncture to treat
laryngeal hemiplegia in horses. Vet. Rec. 165, 602-603. Yan, Q., Ruan, J.W., Ding, Y., Li, W.J., Li, Y. and Zeng, Y.S. (2011)
Electro-acupuncture promotes differentiation of mesenchymal
Mayor, D.F. (2007) Electroacupuncture: an introduction and its use for stem cells, regeneration of nerve fibers and partial functional
peripheral facial paralysis. J. Chin. Med. 84, 1-19. recovery after spinal cord injury. Exp. Toxicol. Pathol. 63, 151-156.
Rose, R.J. and Hodgson, D.R. (2000) Neurology. In: Manual of Equine Yang, C., Li, B., Liu, T.S., Zhao, D.M. and Hu, F.A. (2005) Effect of
Practice, 2nd edn., W.B. Saunders Company, An Imprint of Elsevier, electroacupuncture on proliferation of astrocytes after spinal cord
Philadelphia. pp 503-576. injury. Zhongguo Zhen Jiu 25, 569-572.