A 50-year-old woman presented within two days of acute onset. Without an obvious trigger, she suddenly developed reduced movement on the left side of the face: flattened forehead lines, incomplete eye closure, and deviation of the mouth corner. She also felt tightness and localized aching discomfort in the head and face. There was no obvious ear pain, vertigo, or fever. After onset, she took only a small amount of analgesic and received no systematic treatment. Because she felt symptoms progress quickly and feared lasting deficits, she sought care promptly.
She denied diabetes, stroke, and any history of facial nerve surgery. There was no recent upper respiratory infection or ear inflammation. She was generally healthy. Allergy history was unclear, and there was no known family history of neurological disease. On examination, the left forehead lines were reduced, eye closure was incomplete, the mouth corner deviated to the right when showing teeth, and cheek puffing and whistling were clearly weak—typical signs of acute peripheral facial nerve palsy. Limb strength and tendon reflexes were essentially normal, and no obvious central neurological signs were present. Marked tenderness was found in the neck and the postauricular mastoid region. Multiple tender points and small nodules in the temporal region and cheek reproduced local tightness and a pulling/traction sensation when pressed. No imaging was performed on the day of visit; given the short course and typical clinical picture, the working diagnosis was acute peripheral facial nerve palsy, and she reported no previous abnormal head CT/MRI findings.
The working diagnoses were: Western medicine—acute peripheral facial nerve palsy (Bell’s palsy); TCM—deviation of mouth and eye, categorized as channel involvement with wind-phlegm obstructing the collaterals; Mini Ren-SNAN Acupuncture findings—prominent trigger points and tender nodules in the neck and mastoid region with increased tension along the facial nerve pathway, plus superficial tender micro-nodules in cheek expression muscles indicating a local structural basis for dysfunction.
Treatment: Mini Ren-SNAN Acupuncture was performed using a sterile, single-use mini-blade needle (0.35 mm × 25 mm), with insertion depth under 10 mm. In a supine or slight side-lying position, palpation focused on the neck and mastoid region, especially tender nodules and taut bands in the sternocleidomastoid, upper trapezius, suboccipital muscle group, and mastoid attachment areas. Shallow anti-nodule release was applied along the direction of muscle fibers with careful avoidance of major vessels such as the carotid artery and external jugular vein. Next, trigger-point nodules in the affected-side temporalis and cheek expression muscles were gently released using shallow needling and mild micro-release to reduce swelling and scarring risk. After Mini Ren-SNAN Acupuncture, 0.25 mm × 25 mm filiform needles were applied at GB14, ST2, ST4, ST6, and SJ17 (Yangbai, Sibai, Dicang, Jiache, Yifeng), followed by low-frequency electro-acupuncture for about 20 minutes to activate weakened facial muscles. Treatment was delivered 2–3 times per week, with an initial course of five sessions.
After the first treatment, the patient reported a clear reduction of neck and cheek tightness and improved overall head-face comfort. By the third treatment, eye-closing strength improved markedly and mouth deviation decreased. After five treatments, signs largely resolved: forehead lines returned, eye closure and cheek puffing became symmetric, and facial expressions appeared natural. At three-month follow-up, there was no obvious relapse; only occasional mild tightness occurred with fatigue, without functional impairment.
Discussion: In acute Bell’s palsy, timing and target selection can change the outcome. Many approaches focus only on stimulating the nerve or activating facial muscles, but the facial nerve travels through a corridor of soft tissues. In the acute stage, this corridor can be mechanically overloaded—especially around the neck–mastoid–cheek chain—where trigger points and nodules increase local tension and may worsen the nerve’s micro-environment. Mini Ren-SNAN Acupuncture works as early, controlled soft-tissue unloading releasing neck/mastoid trigger points and nodules can reduce traction and improve local microcirculation, while electro-acupuncture helps re-engage weakened muscles and coordination. The practical message is straightforward: sudden facial weakness should be addressed early, and prompt evaluation plus early unloading of the neck-mastoid tension chain may shorten the course and reduce the chance of lingering asymmetry. Medical assessment remains important, especially to exclude central causes.
Suggest to the patients who are suffering from this issue: If you notice sudden facial weakness—flattened forehead lines, difficulty closing one eye, or mouth deviation—especially with tenderness behind the ear (mastoid area) or strong neck tightness, don’t wait. Early care matters. Book an appointment to meet Dr. Guojian Huang to discuss your symptoms and whether Mini Ren-SNAN Acupuncture, with appropriate electro-acupuncture support, may be right for you. Appointment link: https://ankang.cliniko.com/bookings#service