Head and Face Treatments

Bell’s Palsy

Subjective:

The patient will usually complain of an acute onset of unilateral upper and lower facial paralysis. This may be accompanied by ear pain, decreased hearing, occasionally hyperacusis and taste abnormalities. Onset may be insidious or after infection, trauma, or toxic exposure.

Assessment:

The patient will often notice a decrease in discomfort, especially at night, after the first treatment. Light Treatment Plan: Treatment can begin two to three times per week as long as symptoms are stable or improving.

Begin by painting over the area of palsy as well as the course of the facial nerve with no more than 25 joules. Slowly increase dosage over the course of therapy with a maximum dose of 50 to 600 joules per treatment.

Adjunctive Treatment Plan:

The patient should be educated about proper eye care and in facial exercise techniques. Taping the eye shut at night can make sleeping easier and protect the eye from injury.

Head and Face Treatments

Sinusitis

Subjective:

Patients usually complain of chronic pain in and around one or more of the four sinuses in the frontal and maxillary bones. There may also be nasal stuffiness, the feeling of facial fullness, dental pain, fever, and ear pain.

Assessment:

There will be a decrease in subjective complaints if inflammation and infection are alleviated.

Light Treatment Plan:

Be certain that there is no infection prior to treating with laser therapy. If there is a significant amount of mucous, ask the patient to consult their doctor or start a saline flush before starting laser therapy. The mucous must be loose and draining before using a laser on the sinuses. Once the sinuses have started to drain, paint over the sinuses, starting with a total of 25–100 joules spread over the problematic sinuses, approximately 2 to 3 times per week. Intraoral irradiation into the maxillary sinus, radiation into the nostrils and treatment between the eyebrows can be of benefit.

Only increase the dose if the patient is reporting an improvement in symptoms, and as long as the patient is using a saline wash. Adjunctive Treatment Plan: Washing the sinuses with saline on a regular basis can be very helpful. Check environmental sensitivities or allergic factors as they may predispose some individuals to this condition. Ask the patient to reduce exposure to dust, molds, cigarette smoke, and irritants. In some cases, adding a mild herbal disinfectant to the saline flush or having a physician prescribe a liquid antibiotic from a compounding pharmacy can produce faster, more effective results.

Head and Face Treatments

(TMJ)

Temporomandibular Joint Syndrome

Subjective:

Patients typically complain of pain in and around the TMJ. There is often increased pain with chewing, occasional popping, and clicking. Many patients also complain of an earache, headache, and
limitation of jaw movement.

Assessment:

Improvement is observed as decreased subjective complaints, less muscle spasm, with improving range of jaw motion.

Light Treatment Plan:

Treat the masseter, pterygoids, and temporalis muscles. Rarely does the joint need more than 10 to 100 joules, but the muscles do require a stronger dose. Begin with 25 joules on the first treatment and, with a higher power LED, titrate up to a maximum of 600 joules if condition shows improvement with each increase.

Adjunctive Treatment Plan:

The use of ice and heat is recommended to control inflammation and pain. Educate the patient about bruxism, tongue and jaw position, and the need to avoid clenching. Stress can play a major role in the disturbance of jaw posture and thus stress reduction strategies and behavior modification can be of benefit. Good posture, soft food, and smaller bites can make eating easier. If treatment is ineffective a splint to stabilize the TMJ is another option.

Head and Face Treatments

Tension and Migraine Headaches

Subjective:

Tension headaches are characterized by a generalized aching that tends to be experienced as a constant pressure in the frontal, temporal, and occipital regions. Migraines often have a prodrome and are very severe compared to tension headaches. Many patients state that stress, eyestrain, bad posture, and hunger can aggravate their condition.

Assessment:

Since lab and imaging studies only rule out pathology and are not diagnostic, patient history and pain level are utilized to assess improvement after treatment. Tight muscles in neck and face should decrease.

Light Treatment Plan:

Deliver 100–200 joules to the area of discomfort, primarily the suboccipital and upper cervical regions. Follow this with the painting of the frontal or temporalis muscles if the pain is also present in those regions.

Adjunctive Treatment Plan:

The use of ice and heat is recommended to control inflammation and pain. Additional techniques include cervical stretching exercises, massage, ultrasound therapy, and cranial and cervical spine mobilization. Some patients find benefit from meditation, stress management, and biofeedback techniques. For migraines, medication is often necessary.

Head and Face Treatments

Weight Loss and Body Contouring

Subjective:

The patient complains of difficulty in losing weight.

Assessment:

Girth and weight should show a slow reduction with time.

Light Treatment Plan:

If you have a powerful LED, like 5,000 – 10,000 milliwatts, you will treat the area for about 2 minutes. Adjunctive Treatment Plan: There is a significant amount of research that substantiates using light therapy as an adjunct to other weight loss measures like proper diet, portion control, and exercise. Studies show that adding light therapy to areas of heavy fat deposition may make dieting and exercise more successful. It is thought that light therapy may improve the body’s ability to rid itself of fat in adipose cells.

Head and Face Treatments

Wrinkles

Subjective:

Patient presents with a desire for a smoother facial complexion.

Objective:

The size and depth of lines can be measured, although typically patients are very aware of their facial contours and can report quite accurately if treatment is making a difference.

Assessment:

Patient and therapist can observe a lessened number of the shallower wrinkles.

Light Treatment Plan:

Start treating with 50 to 100 joules the first visit and increase to 200–600 joules if there are no side effects and the patient is happy with the results. It could take one to two months of treatment, 2 to 3 times per week, to produce a significant change.

Adjunctive Treatment Plan:

Make sure the patient is using a quality moisturizing cream after each treatment. Some therapists report that supplementing the treatment with oral hyaluronic acid and essential fatty acids can increase the speed and quality of improvement.

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