Treating facial nerve paralysis with acupuncture - Veterinary Practice News (2025)

While many horses recover with conventional care, those that do not may be euthanized. Evidence indicates acupuncture propels a more rapid resolution of peripheral nerve injury; why wait, then, until all else fails before giving it a try?

January 20, 2025

By Narda G. Robinson, DO, DVM, MS, FAAMA


In veterinary medicine, sometimes the most obvious solution gets overlooked. For example, when a nerve stops firing, it needs stimulation—not more steroids, not more tincture of time. Stimulation. This is especially true for many cases of facial nerve paralysis (FNP) in horses, for which trauma constitutes the most common cause.1

While many horses recover with conventional care (drugs and rest), those that do not may be euthanized. Evidence indicates acupuncture propels a more rapid resolution of peripheral nerve injury; why wait, then, until all else fails before giving it a try?

Why delay?

FNP in horses most frequently presents as a unilateral dysfunction of the muscles of facial expression. Depending on the branches affected, horses may exhibit muzzle deviation, ptyalism, ptosis, insufficient blink reflex, and abnormal ear position. Their inability to fully close their mouth causes them to drop feed, while eyelid dysfunction may lead to corneal ulcers. The presentation of each individual FNP patient depends on which neural pathways sustained injury.

To review, the facial nerve exits the skull through the stylomastoid foramen. From there, it divides into five branches: auricular, auriculopalpebral, buccal, cervical, and digastricus. Sites, where branches traverse bony prominences, make the facial nerve susceptible to trauma. Post-anesthesia FNP usually affects the muzzle, while other traumas "in the field" tend to hit branches that supply the eye and ear. Fortunately, the superficial course of the facial nerve also makes it more amenable to physical medicine interventions, such as acupuncture.

Despite the ease of adding physical medicine modalities, too many clinicians delay adding safe, affordable, and effective treatments, such as electroacupuncture (EA). What good does it do to watch muscles atrophy and hope anti-inflammatories will do the trick instead of instituting neuroprotective solutions immediately? Electrical nerve stimulation provided by EA enhances axon regrowth and accelerates sensorimotor recovery, but the sooner it starts, the better.

Our profession must collectively recognize early integrative rehabilitation and physical medicine constitute safe, effective, and rational treatments capable of preserving and rebuilding neurologic function before permanent deterioration ensues.2

A look at the evidence

A 2020 study indicated 53 percent of horses (29/55) with FNP resolved completely with standard measures, while 11 percent (6/55) experienced unchanged or worsened outcomes. Twenty-five percent (14/55) were euthanized.3 Obviously, room for improvement exists. What can we find in the medical literature?

A 2024 report in the Postgraduate Medical Journal evaluated 60 people with chronic facial nerve dysfunction (Bell's palsy) that had lasted for more than a year.4 During a six-week period, half of the group received EA in which practitioners attached electric leads to acupuncture needles inserted into relevant sites. The other half received transcutaneous electrical nerve stimulation (TENS), which applied electrical stimulation by means of electrodes to the skin surface.

Compared to TENS, EA significantly improved the mean total facial nerve index, which assessed the symmetry of facial expressions.

The authors described the effects of EA as follows: "Extensive research conducted at the cellular and molecular levels demonstrated that the continuous application of exogenous electrical stimulation generates an electric field, which in turn promotes the migration, crawling, and growth of Schwann cells, resulting in an elevated secretion of nerve growth factor (NGF) by the Schwann cell. Under the influence of the electric field, NGF and the structural proteins, microfilaments, and microtubules of axons congregate and accumulate. This phenomenon not only accelerates the rate of nerve growth but also guarantees the accurate growth of nerve fibers toward the distal end of the nerve in accordance with the electric field. EA employs filiform needles as electrodes to induce passive movement in denervated facial mimetic muscles, with the objective of promoting the restoration of facial nerve function by stimulating specific facial expressions."

Other mechanisms include the ability of EA to inhibit neuronal apoptosis and mitigate the peripheral inflammatory response by up-regulating glial cell-derived neurotrophic factor, particularly in facial motor neurons.5 EA also increases the expression of brain-derived neurotrophic factor (BDNF). This reduces neuronal death and provides a microenvironment supportive of neural development.

Another study compared the effects of acupuncture with "no acupuncture" in humans who experienced iatrogenic FNP following surgical resection of vestibular schwannoma.6 Those who received acupuncture showed significant gains in recovery of movement in the muscles of facial expression, while participants assigned to the control group did not. The treatment group also reported less pain and tension, as well as no adverse effects.

A 2013 case report in Equine Veterinary Education documented the benefit of multimodal therapy, including EA, for a horse that sustained FNP secondary to compression by a halter while anesthetized during surgery.7 After two weeks of treatment with anti-inflammatory medications and rest, the FNP persisted, and the muscles of the face were undergoing atrophy. The horse then received EA on the face at points designed to stimulate afflicted nerves and muscles.

Per the authors, "After the first four [daily] treatments, the horse exhibited an improved ability to drink and feed with less cheek impaction and reduced drooling at the left commissure. Weak spontaneous movements of the upper lip were noticed at the end of the first week, and facial asymmetry diminished progressively over the three-week course of treatment. At the end of the second week of treatment, the horse was able to normally prehend the food with his left side of the lips. Atrophy seemed reduced and the food impaction had disappeared. The horse was discharged from hospitalization at the end of the third week with instruction to keep promoting food prehension on the left side of his lips twice daily for one month. One month after discharge from the hospital, a slight asymmetry could be noticed at rest but disappeared while the horse was mobilizing his lips. The horse's training season began six months after the treatment and no exercise intolerance was observed. Furthermore, the left nostril appeared to dilate normally at exercise."

Watch "Treating Facial Nerve Paralysis in a Horse with Acupuncture at UTCVM" on the University of Tennessee College of Veterinary Medicine YouTube channel at https://youtu.be/1Ou3Cz1e48A?si=jhHJTearG6Fztose.

What would have happened if the horse had not received EA? Even after two weeks, the muscles supplied by buccal branches of the facial nerve had atrophied, including the levator nasolabialis, orbicularis oris, levator labii superioris, caninus, depressor labii inferioris, buccinator, and zygomaticus. All these structures are well within reach of acupuncture needles and other forms of physical medicine, which again raises the question, "Why isn't EA included as first-line care?"

Another report describes the successful resolution of FNP in a horse that suffered traumatic injury to branches supplying the orbicularis oculi and the muzzle.8 Unresponsive to a course of dexamethasone, the horse then received EA. By the end of a two-week series, the palpebral reflex returned to normal. Following one month, the drooping lower lip recovered nearly completely.

Watch this clip for a before-and-after presentation of a mare that received medical acupuncture for facial and trigeminal nerve injury after medication failed:https://youtube.com/shorts/1RAEwOuim6A?si=4blubXRNbR7i5jY4

Conclusion

Designing an effective EA protocol for FNP is not difficult. Note how the facial nerve trajectory (Figure 1) overlaps with acupuncture points on the lateral face and near the eye (Figure 2). These points serve as suggested sites for treatment inclusion but are not the only sites one could select.

Taking a neuroanatomic approach, veterinary medical acupuncturists begin by inserting a needle near the facial nerve trunk soon after it exits the skull at an acupuncture point called "Triple Heater 17," or TH 17. They then add needles proximal and distal to the traumatized branch(es) and the neuromuscular destination. In so doing, the practitioner activates both afferent (through the trigeminal nerve) and efferent (through the facial nerve) impulses through the site; this may provoke a motor twitch at the previously paralyzed muscle. Adjunctive modalities may include photomedicine9 and massage.10

Approaching acupuncture in this way transcends the need to believe in myths, metaphors, demons, and chi while specifically targeting the neurologic lesion. No incense or chanting required.

This handout illustrates the anatomic relationships between acupuncture points and nerves, specifically for facial and trigeminal nerve injury cases: download link.

Narda G. Robinson, DO, DVM, MS, FAAMA, practices osteopathic medicine and veterinary medicine. Dr. Robinson taught science-based integrative medicine at the Colorado State University College of Veterinary Medicine and Biomedical Sciences for 20 years. In 2016, Robinson established her own academy in Fort Collins, Colo., where she teaches medical acupuncture, integrative rehabilitation, medical massage, and other integrative medical approaches. Columnists' opinions do not necessarily reflect those of Veterinary Practice News.

References

  1. Boorman S, Scherrer NM, Stefanovski D, et al. Facial nerve paralysis in 64 equids: Clinical variables, diagnosis, and outcome. J Vet Intern Med. 2020; 34:1308-1320.
  2. Gouveia D, Cardoso A, Carvalho C, et al. Early intensive neurorehabilitation in traumatic peripheral nerve injury – state of the art. Animals (Basel). 2024 Mar 13; 14(6):884.
  3. Boorman S, Scherrer NM, Stefanovski D, et al. Facial nerve paralysis in 64 equids: Clinical variables, diagnosis, and outcome. J Vet Intern Med. 2020;34:1308-1320.
  4. Li T, Wang S, Yin X, et al. Electroacupuncture with intermittent wave stimulation as rehabilitation approach for chronic Bell's palsy: a randomized controlled trial. Postgraduate Medical Journal. 2024,100,1181, 151-158.
  5. Fei J., Gao L., Li H.-H., Yuan Q.-L., Li L.-J. Electroacupuncture promotes peripheral nerve regeneration after facial nerve crush injury and upregulates the expression of glial cell-derived neurotrophic factor. Neural Regen. Res. 2019;14:673–682. doi: 10.4103/1673-5374.247471.
  6. Pu JK-S, Wong SC-S, So KH-T et al. Acupuncture as part of iatrogenic facial nerve palsy rehabilitation – first report. World Neurosurgery. 2020;140:e343-e347.
  7. deFourmestraux C, Tessler C, and Touzot-Jourde G. Multimodal therapy including electroacupuncture for the treatment of facial nerve paralysis in a horse. Equine Vet Educ. 2013;26(1):18-23.
  8. Jeong HS, Kim NS, and Kim M-S. Use of electroacupuncture treatment on traumatic facial nerve paralysis in a horse. J Vet Clin. 2015;32(1):105-107.
  9. Er-Rouassi H, Benichou L, Lyoussi B and Vidal C (2022) Efficacy of LED Photobiomodulation for Functional and Axonal Regeneration After Facial Nerve Section-Suture. Front. Neurol. 13:827218. doi: 10.3389/fneur.2022.827218.
  10. Schubert, T. Facial paralysis in horses. (Pet Owner Version). Merck Veterinary Manual. May 2019. Accessed at https://www.merckvetmanual.com/horse-owners/brain-spinal-cord-and-nerve-disorders-of-horses/facial-paralysis-in-horses on 11.20.24.
  11. UT College of Veterinary Medicine YouTube Channel. Treating facial nerve paralysis in a horse with acupuncture at UTCVM. Available at https://www.youtube.com/watch?v=1Ou3Cz1e48A .
Treating facial nerve paralysis with acupuncture - Veterinary Practice News (2025)
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