Physical Therapy Treatment Strategies for Facial Nerve Weakness and Paralysis Due to Peripheral and Central Pathologies: Efficacy and Outcomes

Background: Facial nerve disorders are commonly treated by various physical therapy strategies to improve outcomes, but there are many questions about their efficacy.

Objectives: We performed a retrospective study to evaluate physical therapy outcomes for Bell's palsy as well as other causes of facial palsy.

Selection Criteria: We selected any patient that was treated with physical therapy, with or without facial nerve reconstruction surgery. We included participants of any age > 18 with a diagnosis of Bell's palsy, after resection of Vestibular schwannoma, Ramsay Hunt syndrome, iatrogenic facial disorders, parotid malignancy, hemi facial spasm and temporal bone Trauma. The outcome measures were Level of recovery six months after treatment, synkinesis, amount of facial spasm, incomplete adverse effects attributable to the intervention. The Synkinesis Assessment Questionnaire (SAQ), House-Brackmann facial nerve grading scale and eFace Quantitative Assessment for Facial Symmetry were used to assess synkinesis and function pre- and posttreatment as well.

Data Collection and Analysis: Two authors independently gathered data from the electronic medical record and reviewed patient data between the years 2018 and 2022. The authors independently performed risk of bias assessments, which took into account secure methods of randomization, allocation concealment, observer blinding, incomplete outcome data, selective outcome reporting, and other biases for a retrospective review.

Main Results: For this study, 150 participants were selected. For most outcomes, we were able to perform data analysis because the interventions and outcomes were comparable when the groups were divided by diagnosis and facial nerve palsy pathophysiology. For the primary outcome of incomplete recovery after six months, Physiotherapy produced no benefit over conventional therapy. Participants after facial exercises: were at higher risk of bias, found no difference in incomplete recovery at six months when exercises were compared with waiting list controls or conventional therapy only.

Conclusions: There is no high quality evidence to support significant benefit or harm from any physical therapy for facial paralysis and weakness disorders. Further good quality prospective randomized controlled trials studies with a larger group of patients and longer follow-up are required.

Publication History

Article published online:
01 February 2023