Advanced Physiotherapy Solutions for Facial Palsy

Facial palsy is also termed Bell’s palsy and has relatively higher incidents in India as compared to any other country.

But what exactly is facial palsy???

It is a condition that generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve. When a facial nerve is either non-functioning or missing, the muscles in the face do not receive the necessary signals in order to function properly. This results in paralysis of the affected part of the face, which can affect movement of the eyes and the mouth, as well as other areas.

There are different degrees of facial paralysis: sometimes only the lower half of the face is affected, sometimes one whole side of the face is affected, and in some cases both sides of the face are affected. To add on, this condition is caused by damage to the facial nerve (i.e., cranial nerve VII) that supplies the muscles of the face. It can be categorized into two types based on the location of the casual pathology:

• Central facial palsy : Due to damage above the facial nucleus

Peripheral facial palsy: due to damage at or below the facial nucleus.

Did You Know? Some infections can also lead to facial palsy.

If no, then go on reading as we discuss the various causes of this condition.

Though most of the time this condition arises due to acute facial nerve paralysis, and there is no known cause of Bell’s palsy, it is also associated with:

1. Herpes simplex infection, causing acute facial paralysis. It develops over days and can last for upto months

2. Infections: Lyme disease & Varicella zoster virus (Ramsay Hunt syndrome) can cause facial palsy. Lyme disease is an infection caused by Borrelia burgdorferi bacteria and accounts for about 25% of cases of facial palsy, whereas Ramsay-Hunt syndrome includes ear pain or even hearing loss.

3. Ear infections like otitis media: an infection in the middle ear may outspread to the facial nerve and inflame it. Such infections may require immediate surgical interventions as well.

4. Trauma: when caused by a fracture in the temporal bone, it can lead to damage to the facial nerve, leading to facial palsy. In cases of transverse fractures, there’s a higher risk of getting the face paralyzed.

5. Tumors: Sometimes neuromas, cholesteatomas, and parotid tumors compress the facial nerve, and this then leads to progressive facial paralysis.

6. Stroke: Facial palsy caused by a stroke and primarily affects the lower face.

Other causes may include: Diabetes mellitus

Facial nerve paralysis, sometimes bilateral, is a common manifestation of sarcoidosis of the nervous system, neurosarcoidosis.

Bilateral facial nerve paralysis may occur in Guillain-Barré syndrome, an autoimmune condition of the peripheral nervous system.

Moebius syndrome is a bilateral facial paralysis resulting from the underdevelopment of the VII cranial nerve (facial nerve), which is present at birth. The VI cranial nerve, which controls lateral eye movement, also gets affected, so people with Moebius syndrome cannot form facial expressions or move their eyes from side to side.

Facial piercings, namely eyebrow piercings or tongue piercings, can in very rare cases cause damage to the facial nerve.

Signs and symptoms

Facial nerve paralysis is characterized by facial weakness, usually only on one side of the face, with other symptoms possibly including: 

- Loss of Taste

- Hyperacusis

- Decreased Salivation

- And Tear Secretion

- Inability to close the eye

- Inability to move the lips (e.g. into a smile, pucker)

- At rest, the affected side of the face may "droop."

Managing Facial Palsy with Advanced Physiotherapy at ABTP

At times, tumors such as acoustic neuromas and facial schwannomas are frequently resected surgically also. For patients with dense facial palsy and no nerve function, a number of surgical interventions may be used.

These fall into the following categories:

1. Facial reanimation surgeries which involve nerve graft or anastomosis

2. Facial reanimation surgeries which involve muscle transposition

3. Static surgery (i.e., plastic surgery) is used to improve symmetry at rest but does not improve movement.

Various modalities or techniques of advanced physiotherapy are also employed at the ABTP centres to help the patients overcome the challenges of facial palsy, enabling them to resume normal living patterns

Neuromuscular retraining (NMR) 

It is a process of making the facial muscles relearn facial movements using specific and accurate feedback to

 (1) facilitate facial muscle activity in functional patterns of facial movement and expression

 (2) suppress abnormal muscle activity interfering with facial function.

Electromyography (EMG) and mirror biofeedback

In facial palsy, EMG (electromyography) combined with biofeedback is a therapeutic technique utilized at ABTP to help patients regain control over facial muscles by providing real-time visual or auditory feedback on their muscle activity, allowing them to consciously learn how to activate and coordinate facial movements.

Trophic electrical stimulation (TES) 

Trophic electrical stimulation is a treatment aimed at restoring the function of the muscles of the face by mimicking the stimulation provided by normal nerve functioning. Electrical stimulation has been widely used over the years and is known to help certain nerve muscle problems. Initial stimulation techniques focused on making the muscle move with the electrical impulses, hoping that this would promote recovery (faradism). With new advances in technology, it is now possible to embark on a more specific conditioning of the system involved. 

Proprioceptive neuromuscular facilitation (PNF) techniques and Kabat technique. 

Proprioceptive neuromuscular facilitation (PNF) is a technique used to treat facial palsy (FP), which is damage to the seventh cranial nerve. PNF can help improve facial expression and reduce facial disability.

·         PNF helps increase muscle activation in muscles that are supposed to move but aren't

·         PNF helps decrease muscle activation in muscles that aren't supposed to move.

MIME THERAPY

Includes treatments such as:

• Self-massage

• Step 1: Begin by trying to move every part of your face slowly and gently.

• Step 2: Use your fingers to gently lift your eyebrows.

• Step 3: Using your fingers, gently massage the different parts of your face, including your forehead, nose, cheeks, and mouth.

Then there are breathing and relaxation activities

Furthermore, there are exercises to enhance coordination between both sides of the face and to reduce synkinesis, to help with eye and lip closure to restore normal facial muscle functioning

Also, kinesiotaping helps in stretching the facial muscles and reducing overactivity on the working side of the face.

In conclusion, facial palsy usually reflects the weakness or paralysis on one side of the face due to damage to the facial nerve, leading to difficulties with facial expressions, eating, and eye protection. While most people recover significantly within a few months with advanced physiotherapy at ABTP, a small percentage may experience permanent facial weakness, highlighting the importance of early diagnosis and management by a healthcare professional to optimize recovery potential.