Comparison of acupuncture intervention from the acute phase or the non-acute phase in patients with peripheral facial paralysis: a systematic review and meta-analysis

Lele ZhangMin YeHongyu XieYingju HuAihong Yuan^*

• First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China

This study compared the effectiveness of acupuncture administered during the acute versus non-acute phases of PFP. A systematic search of eight databases was conducted for relevant literature published from inception until July 1, 2025. This study included randomized controlled trials (RCTs) that met the predetermined inclusion criteria. The evaluated outcomes encompassed the clinical effective rate, House-Brackmann Facial Nerve Grading Scale (H-B scale), Facial Disability Index (FDI), cure time, Portmann Simple Score Scale (Portmann score), and non-cure rate at 1-month follow-up. Study selection and data extraction were performed independently by two reviewers. This study utilized the Cochrane Risk of Bias tool and the GRADE framework to assess methodological quality and evidence certainty, respectively. Data analysis was conducted using Review Manager 5.4 and Stata 15.0, with results expressed as relative risk (RR) or mean difference (MD) with corresponding 95% confidence intervals (95% CI). This meta-analysis included fifteen randomized controlled trials involving 771 patients, with the majority demonstrating an unclear or low risk of bias. Pooled results indicated that acupuncture as an adjunctive therapy significantly improved the clinical effective rate (RR=1.11, 95% CI [1.06, 1.16], P<0.0001), corresponding to an 11% relative increase in the probability of treatment success. Significant improvements were also observed in facial nerve function, as measured by the H-B scale (MD = -0.56, 95% CI [-0.92, -0.20], Z = 3.03, P = 0.002) , FDI Physical Function subscale (MD = 2.57, 95% CI [0.54, 4.59], Z = 2.48, P = 0.01) and Portmann score (MD = 3.69, 95% CI [0.50, 6.87], Z = 2.27, P = 0.02). Additionally, acupuncture substantially reduced cure time (MD=-10.71 days, 95% CI [-16.33, -5.09], P=0.0002). In contrast, neither the FDI Social Function subscale (MD=-0.89, 95% CI [-2.48, 0.71], P=0.28) nor the non-cure rate at 1-month follow-up (RR=0.63, 95% CI [0.21, 1.91], P=0.42) showed statistically significant improvement. This synthesis provides preliminary evidence that integrating acupuncture with Western medicine during the acute phase of PFP may enhance clinical response rates and accelerate facial functional recovery. However, these conclusions are tempered by methodological limitations observed in the included trials, particularly concerning potential biases and small sample sizes.