Physiotherapy for Facial Palsy

What is facial palsy?

Facial palsy refers to paralysis of the muscles of the face, typically due to loss of function of the facial nerve.   If the facial nerve is not working, trying to make the muscles in the face move is like trying to turn a lamp on and off when it is not plugged into a wall.  Up to 10,000 Australians are affected every year.

What causes facial palsy?

  • There are many causes of facial palsy, the most common causes are:

  • Viral- for example Bell’s Palsy (due to HSV virus), Ramsay Hunt Syndrome (from the varicella/shingles virus).  Other viruses that can result in facial palsy include HIV, CMV, Epstein Barr Virus

  • Benign tumours- e.g. acoustic neuroma/vestibular schwannoma, meningioma, facial nerve neuroma, cholesteatoma

  • Traumatic injury e.g. skull base fracture, lacerations, surgery

  • Peripheral neurological conditions such as Guillain Barre Disease, Neurofibramatosis

  • Autoimmune diseases

  • Stroke

  • Congenital facial palsy

  • Factors that predispose to facial palsy include diabetes, hypertension and pregnancy.

What are some of the impacts of facial palsy?

The facial nerve is important for many functions, including

  • Protecting and hydrating the eyes

  • Closing eyes to blink and sleep

  • Speech

  • Non-verbal communication

  • Emotional display

  • Eating and drinking

  • Breathing through the nose

  • Whistling, playing an instrument, snorkelling, kissing.

Our face is our way of communicating with others, over 50% of which is non-verbal.    Facial palsy is more than a cosmetic issue – it is a communication disorder.    It can have a significant impact on a person’s social and emotional wellbeing as well as physical complications.  

What happens in facial palsy, and how long does it take to recover?

The nerve that supplies the facial muscles is damaged.  There are three levels of injury:

  1. Neuropraxia – a compression injury that usually recovers in about six weeks

  2. Axonometsis – more significant damage, requiring the nerves to regrow.  Recovery may not begin for up to four months.

  3. Neurotmesis – the nerve is fully severed and requires surgery.

  4. As the nerve recovers or regrows, electrical transmission to the muscles is gradually restored and they begin to work again.   Sometimes this happens smoothly but sometimes muscles can feel stiff and tight or move involuntarily (known as synkinesis) if the rewiring process is affected as recovery occurs. 

What can physiotherapy help with?

Physiotherapy can help with many aspects of recovering from facial palsy.  To communicate with our face, we require:

  • Adequate strength in the muscles

  • Mobility/flexibility in the soft tissues - stiff and tight muscles will have more difficulty

  • Precise coordination between muscles and between the two sides of the face

  • Accurate control of these muscles

The return of muscle strength is determined by the speed of recovery of the nerve and cannot be ‘accelerated’.   Physiotherapy in facial palsy in the early stages of recovery aims to:

  • Help you to understand your condition and prognosis

  • Enhance communication and function whilst the face recovers, to maximise participation in life activities

  • Optimise eye care to prevent eye damage, and oral care to prevent complications

  • Enhance comfort

  • Prevent the muscles from shortening whilst they recover

  • Prevent overuse and tightness through the other side of the face (which can lead to asymmetry and inhibit function of the affected side as it begins to recover)

  • Screen for psychosocial distress and refer on for management if needed

  • Physiotherapists can also identify if further medical or surgical management may be required.

Treatment typically includes education, specific strategies to manage dry eyes/mouth and teaching appropriate stretches, facial taping and massage, depending on individual requirements.

As the nerve supply starts to return and muscles start to function again, the focus shifts towards:

  • Addressing any soft tissue restriction which may inhibit return of full movement or contribute to development of synkinesis

  • Retraining normal, symmetrical movement of the face

When should I see a Physiotherapist if I have developed a facial palsy?

It is a good idea to see a physiotherapist with training in facial palsy rehabilitation if you have not had any signs of recovery by four weeks, or don’t have full recovery by six weeks.  Review frequency is determined by speed of progress, but emphasis is on empowering the person with facial palsy to manage their own rehabilitation.

If you have had facial palsy for a long time and have synkinesis, it is still possible to reorganise muscle activity and ‘retrain the brain’ even years later.    

For further information or if you would like to know more about Physiotherapy for Facial Palsy, please contact our clinic on 4207 0279.

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