Different rehabilitation approaches to the recovery of facial palsy: a case series

Autori

Di Dio Antonio (Università di Messina, Messina, Italy)

Saraceno Silvia (Università di Messina, Messina, Italy)

Sposito Francesca (Università di Messina, Messina, Italy)

Di Marco Giada (Università di Messina, Messina, Italy)

Cavallaro Filippo (Università di Messina, Messina, Italy)

Bonanno Francesco (Università di Messina, Messina, Italy)

Background and aims

The idiopathic facial paralysis, also called Bell’s palsy, is an acute unilateral peripheral facial paralysis, due to an alteration of the facial nerve. It causes muscle weakness on one side of the face, leading to asymmetry, inability to close the eye or mouth, and drooping of the brow or mouth corner, leading to difficulties in daily activities like seeing, speaking, and eating [1]. Rehabilitation is an important issue in peripheral facial nerve palsy management. Different approaches have been applied, but nowadays there is no evidence that any particular technique is better than others. This work highlights the potential benefits of Cognitive Therapeutic Exercises (CTE) in the non-pharmacological management of facial palsy, despite limited literature evidence.

Methods

A total of 4 patients (2 males and 2 females) between 2017 and 2022, with a mean age of 35 were included in our study. All the patients presented a grade IV in the House-Brackmann classification. A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression.

All the patients followed a rehabilitation program performing CTE exercises with the supervision of a physiotherapist. The length and number of sessions depended on the patient’s response to the exercises proposed. CTE exercises consisted in:

– Recognition of Lego bricks (different in length and thickness) and makeup brushes (with different bristles) in areas affected by the sensorimotor deficit (lip, cheek, eyelid and forehead);

– Recognition of tongue depressors (from 1 to 5) placed between teeth or lips;

– Recognition of the direction of disturbance (up, down, right or left) on a balloon held between the lips.

Results

The exercises having as unit of action the neuromuscular compartmentalization and acting on the neuromuscular plate, determine a recovery of the impaired function. In addition, the attention that patients put in place leads to a conscientization of the area affected by the pathology accelerating the recovery process.

Each patients was evaluated at the first session (T0) and after every 10 sessions (although in each session the physiotherapist assessed and monitored the patient’s clinical condition).

After 20 sessions all the patients showed an improvement in in House-Brackmann score (from grade IV to grade III).

Conclusion

In literature there is not a unique rehabilitation methods about the treatment of this pathology. This work demonstrate how CTE exercises can be very useful for the recovery of the patients affected by facial palsy. Further studies are needed to confirm its efficacy.

REFERENCES

1. Nakano H et al Physical therapy for peripheral facial palsy: A systematic review and meta-analysis. Auris Nasus Larynx. 2024 Feb