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Acupuncture Malpractice Insurance – Neuromuscular Facial Conditions Part 1



So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name’s Michelle Gillis. I am an acupuncture physician practicing in Florida, and today I am going to be speaking to you about treating neuromuscular facial conditions. This is part one of a part two presentation. First slide, please.

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So this is just a little bit about me. I am a former faculty member of the Maryland University of Integrative Health, and I am currently on the doctoral faculty at Yo Sound University, and I. I have been teaching facial acupuncture classes internationally since 2005. Here are some publications that I have completed in the Journal of Chinese Medicine.

So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.

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So a neuromuscular facial condition is any group of disorders which can cause weakness or pain on one or both sides of your face, you might lose the ability to make facial expressions have . Pain, difficulty eating, drinking, speaking clearly. You can have ear pain, you can lose your sense of taste, smell, it can affect your eyes, your vision.

And you can also have the inability to sense heat or cold or be very sensitive to the heat or cold. What I have discovered over many years in practice is that using a multifaceted approach to treating these conditions, because some of them can be very difficult to treat, and using a multifaceted approach, can yield a more effective treatment than just using one of these modalities or the other.

Some examples of neuromuscular facial conditions is are Bell’s palsy, Ramsay Hunt syndrome, posis of the eyelids, and this can be one eyelid or both eyelids, synkinesis, which is when you’re trying to move one. Part of your face, but another part moves involuntarily. The side effects of a stroke TMJ Trigeminal Neuralgia multiple sclerosis, and there are many others I.

Part one and two of this presentation represents about an hour of what is usually a two-day class that I teach on treating neuromuscular facial conditions.

So the interesting thing about our face is that our face is the only part of our body where the skin is connected directly to the muscles, which is what gives the. Our ability to move the skin on our face without having to move any bones or ligaments or tendons. So here we have an example. We have skin, and then we have muscle.

And as you can see it, the skin is connected directly to the muscle and then down to the bone.

For example, here is a cross section of a part of the cheek, and you can see the skin and then the fat, and then the fascia and invested inside of this fascial layer is the muscle, and then there is deeper fascia and there is the facial nerve.

When treating the face, there are several things that’s, that are important and you wanna make sure you are increasing the blood flow to the area. I. Increasing the qi to the area and also if there’s any fossil adhesions that exist, that you can break these up because all of this can affect how the face moves and the sensations that we feel.

By using a technique called submuscular needling. In some instances it’s intramuscular needling, but submuscular needling can increase the flow of blood and QI to the area can help to break up any fascial adhesions. And if you are thinking in terms of . Cosmetic benefits. It can also stimulate collagen production to the area.

There are several muscles on the face, head and neck that are really conducive to this submuscular needling approach. And they are the auricular muscles, the temporalis muscle, the platysma, the masseter, the anterior digastric. The frontal, the proces, the corrugator, and the levator muscle. We are only gonna speak about a couple of those today.

And the using submuscular needling is part of this. Multifaceted approach. So in addition to Submuscular needling, we’re also going to talk today about scalp acupuncture, and then next time facial motor points, facial cupping and guha and derma rolling.

So here is another cross section of the face. And as you can see, the facial nerve is invested in this it’s called the SMA layer. It is the superficial muscular AERA system, and the nerve can become entrapped. And when that happens the signal that gets to the muscle, which in turn goes out to the skin, which moves the skin on our face, moves, the muscles in our face can become compromised.

So the first muscle I wanna talk about for Submuscular needling is the frontals and. The frontals muscle goes on either side of the eyebrows. There’s one head on one side of the eyebrow and one on the other. And what you would do is you would take, typically I do half inch needles and I would needle underneath the muscle.

And this is what it looks like here.

So when needling the frontals muscle, the way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows, okay? And then relax and you can find the border of the frontals muscle and the way that you needle. Is you’re going to go from the origin to the insertion.

So the origin is up here and the insertion is here.

And typically what I do is I will put in. Usually three needles

on the lateral edge, and I will put in two needles. On the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in. So if you go like this, it’s going to go too deep. If you go this is going to be too shallow, I use. My thumb or a finger to help to guide the needle.

So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle. That’s the lateral side. Then you’re going to do the medial side, and usually two needles. Will suffice and I do the one side and then I do the other side and I’m using half inch needles.

You can use one inch needles depending on how big your patience forehead is.

The next muscle group. That I’m going to demonstrate for submuscular needling is the temporalis. So the frontalis is used to raise the eyebrows, and it’s also indirectly involved in raising the eyelids, the temporalis muscle, which is a large. Very thin, fan shaped muscle that’s on either side of the skull and it also goes in front of the ear.

It helps us with our chewing and it helps to, so it helps to elevate the jaw and it can be involved with conditions like TMJ. It can also cause head. Pain. If it is too tight, it can be involved in trigeminal neuralgia because nerves can become entrapped underneath the temporalis. I. And this is what this looks like.

So here’s the temporalis muscle, and what you would do is take needles and put them all around the outside of the temporalis. And I have a video for that as well.

So for the temporalis muscle. The idea is to find the outline of the muscle and it tends to be a very large muscle. It runs all the way from the back of the skull all the way around the front of the face. And you’re literally going to take the needles and you are just gonna work your way around.

The entire line of the muscle, and depending on how tolerant your patient is you can use, you can really thread like 20 of these into this area. I’m just doing a little demonstration here I want you guys to get an idea of what this looks like. And it doesn’t really matter which direction you’re going in.

What matters is that you’re getting, again, underneath the muscle and that you’re working your way all around the perimeter of the muscle in order to relax it. And they should have a nice little circle around. A muscle when you’re done, and this will really help to relax the temporalis muscle if they have TMJ.

Pretty much anything that affects the face. The temporalis muscle helps to pull the face up. I use this technique sometimes and facial rejuvenation when I teach my facial rejuvenation classes because the temporalis muscle can really lift up the face. I’m just gonna do one more again. I’m using serum one inch.

Needles. So that’s what that looks like.

So for the temper, the next. Technique that I use when I’m treating neuromuscular facial conditions is scalp acupuncture. Now, scalp acupuncture can be used and it is used traditionally to treat a multitude of. Conditions, everything from phantom pain to speech issues, to inability to move a body part.

But when I use and teach scalp acupuncture, it involves issues concerning the face. So when we when we would incorporate scalp acupuncture. We could use this in conjunction with submuscular needling or as a standalone technique, so any conditions that involve the face scalp, acupuncture can be very effective.

I. Especially when you’re dealing with a condition like trigeminal neuralgia where it’s very painful to needle directly onto someone’s face, you can use scalp acupuncture and this will treat the face without having to directly put needles in the person’s face. So here we have a cross section of the scalp.

We have the skin, we have the close connective tissue, and this is very heavily vascularized with lots of nerves. Then we have the aosis. Right below that is the loose connective tissue, and this is where you would want to insert the needle. Right below that is the perran and that is the skull. The good news is that when you’re trying to find the right depth to needle, if you just go down as deep as you can along the bone.

Then ’cause it, you, it is impossible to put an acupuncture needle through someone’s skull bone. You can needle right along the bone and if you get into the loose connective tissue, it will not be painful. If you go into the close connective tissue, you’re going through vessels and nerves, and it can be very painful.

So the thing that can be the most important thing to learn when you’re learning scalp acupuncture is how to measure. So the, you’re basically going to, these are not acupuncture points. These are areas of the. Scalp that affect different areas of the brain. And the way you measure is you’re going to get your horizontal and vertical planes, and then you will find the area of treatment based on that.

So the first landmark is from the glabella to the occipital protuberance, and the glabella is at the midpoint. Of you’re gonna get to the glabella is between the eyebrows and you’re gonna measure back to the occipital perturbance. And this will give you your line this way. And then you are going to find the midpoint, and that is the midpoint of the midline.

And if you go a half a centimeter. Behind the midpoint, that is where you’re going to be drawing a line. Right here. So you’re going to find the midpoint of the eyebrow and also go back to the occipital protuberance. And when you go back 0.5 centimeters, you’re gonna draw a line that intersects just like this, and you’re gonna break this up into three sections.

So the lower two fifths. Is this is where you would needle for concerns of the face? The upper extremities is the . Middle two fifths and then the upper one. Fifth is the lower extremities. So the lower extremities are the legs, the spine, the trunk, and the neck. And the upper extremities is just the arms and the hands.

And this bottom two fifths is the face. So this is the area that we would want to needle.

The technique for needling looks like this.

When you’re needling the scalp, it’s important to angle the needle properly so that it goes into the loose connective tissue. I like using a tube. You can freehand if you’d like, but I find that the tube helps me to guide the needle to the correct depth. I tap the needle in, remove the tube, and then I use my free hand to guide the needle

if the needle is improperly. Your patient should not feel any pain. So you’ll know that you’re into the loose connective tissue. If your patient doesn’t have any pain, when you needle, once the needle is in, you stimulate it gently for 30 seconds just like this. Or you can use electricity.

So that concludes our lecture today. So we covered Submuscular needling and we covered scalp acupuncture. Next time we are going to talk about facial motor points, facial cupping, GU Shaw, and derma rolling, and then some protocols for specific conditions. And I look forward to seeing you next time.


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