Recovery from Idiopathic Facial Paralysis (Bell’s Palsy) Using Photobiomodulation in Patients Non-Responsive to Standard Treatment: A Case Series Study

Abstract

Diminished facial movement and marked facial asymmetry can lead to a consistent psychological burden. Bell′s palsy (BP) is one of the most common causes of facial nerve illness, which comes with unilateral acute facial paresis. Nowadays, no clear guidelines for treating BP are available. We carried out a case series study to test the efficacy of photobiomodulation (PBM) therapy in patients with BP non-responsive to standard treatment. The study was experimentally performed at the Department of Surgical and Diagnostic Sciences, University of Genoa (Genoa, Italy), in accordance with case report guidelines. Patients were referred to our department by colleagues for evaluation to be included in the case series because no consistent improvement was observed at least 3 months from the diagnosis of BP. All the patients interrupted their pharmacological therapy before the initiation of PBM therapy. PBM therapy (808 nm, 1 W irradiated in continuous-wave for 60 s on spot-size 1 cm2; 1 W/cm2; 60 J/cm2; and 60 J) was administered every 2 days until complete resolution. Evaluation of the House-Brackmann scale was performed before and after treatments. Fourteen patients were screened as eligible for the study. Patients were Caucasians (36% females and 64% males) with a mean age ± standard deviation of 56.07 ± 15.21 years. Eleven patients out of 14, who experienced BP a maximum of 6 months, completely recovered through PBM. The three patients that did not show improvement were those who had experienced BP for years. PBM could be a supportive therapy for the management of BP in patients non-responsive to standard treatment. However, randomized controlled trials are necessary to sustain our encouraging results, exclude bias, and better explain the boundary between the time from diagnosis and the recovery of BP through PBM therapy.

Management of Bell’s Palsy with Phototherapy

“…We have identified fourteen relevant papers covering the use of phototherapy in the management of Bell's Palsy, including four RCTs [28,[32][33][34], one prospective study [35], one case series [36], and eight case reports [29,[37][38][39][40][41][42][43], which we review.…”

“…Our review shows that the most studied PBM is LLLT [28,32,33,35,37,39,40,42,43]. Others include high-intensity laser therapy (HILT) [29,32,36,41], monochromatic infrared energy (MIRE) [38] and laser acupuncture [34]. Rubis [41] combined PBM with cervical manipulation.…”

“…A review of the search results showed that acute and subacute Bell's palsy respond favorably to PBM [32,33,[37][38][39][40][41][42]. Chronic Bell's palsy, however, responds less satisfactory [34,36,38]. Therefore, PBM seems to be a good complementary treatment to the standard treatment with medication.…”

808-nm Photobiomodulation Affects the Viability of a Head and Neck Squamous Carcinoma Cellular Model, Acting on Energy Metabolism and Oxidative Stress Production

“…Therefore, the flat-top technology supports the uniformity of photobiomodulation treatments and enhances the rigor and reproducibility of PBM clinical outcomes [ 39 , 40 ]. PBM therapy parameters were chosen based on our prior work showing the supportive effect of 808 nm laser treatment at 1 W for 60 s with a spot size area of 1 cm 2 in vitro on endothelial [ 41 ] and stem cells [ 42 , 43 ], as well as in vivo on patients affected by aphthae [ 44 ] and Bell’s palsy [ 45 ]. To support the safety of 808 nm PBM and in accordance with a possible power decrement across tissues, a range of powers from 0.25 W up to 1.25 W was examined, as described in Figure 1 .…”

A Narrative Review on Oral and Periodontal Bacteria Microbiota Photobiomodulation, through Visible and Near-Infrared Light: From the Origins to Modern Therapies

“…The primary PBM targets are linked to the endogenous release of reactive oxygen species (ROS) and NO, ATP production, and modulation of Ca 2+ fluxes and redox homeostasis, which can play a key role in cell proliferation, growth, and apoptosis [66][67][68]. Therefore, PBM therapy seems to support treatments in many medical and veterinary areas to restore cell dysfunction and promote recovery from illness [62,[69][70][71][72][73][74][75]. PBM therapy has been recommended unequivocally for oral mucositis prevention in patients treated with chemotherapy by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology [76].…”