Francesco Bonanno (Università degli studi di Messina)
Mariachiara Ceccio (Università degli studi di Messina)
Teresa Pintaudi (Università degli studi di Messina)
Filippo Cavallaro (Università degli studi di Messina)
Facial nerve palsy is a clinical diagnosis differentiating between central upper motor neuron lesions (e.g., stroke) and peripheral lower motor neuron lesions (e.g., idiopathic or caused by infection or trauma or surgery). Peripheral facial nerve palsy has various causes; the most common is Bell’s palsy (approximately 75% of all cases)1, which has a better prognosis than secondary causes. Secondary causes include neoplasms, such as acoustic neuroma and facial nerve schwannoma, and/or surgical adverse. It has been reported that after removal of an acoustic nerve schwannoma or neuroma, facial nerve palsy might occur in up to 70 percent of cases1. Rehabilitation is an important issue in peripheral facial nerve palsy management. Different approaches have been applied, such as exercise therapy, electrotherapy, massage, lymph drainage, and biofeedback therapy2, but there is no evidence that any particular technique is better than others.
Our aim is to conduct a meta-analysis in order to understand and to investigate the therapies, the management and the complexity of pathology.
A meta-analysis of the literature was conduct on the rehabilitation methods used in facial palsy. We searched English articles published from 2004 to 2024, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The electronic databases PubMed, Scopus, Cochrane Library were investigated, using the following key words, which were combined to achieve maximum search strategy sensitivity: (“facial palsy”) AND (“physiotherapy”) AND (“rehabilitation”).
First, articles were screened by title and abstract, using the following inclusion criteria for selection: (1) randomized controlled trials (RCTs); (2) written in English language; (3) published on indexed journals from 2004 to 2024.
The exclusion criteria were: (1) non-randomized trials; (2) reviews; (3) papers written in other languages than English. Second, the full texts of the selected articles were screened with further exclusions according to the previously described criteria. A PRISMA flowchart of the selection and screening method is provided in Figure 1.
Table 1 summaries the principal key point of each article analyzed. All the author proposed different type of therapeutic protocols (Kabat, laser therapy, neuro-mobilisation), showing improvements in all validated score scale (such as House-Brackmann scale and Facial Disability Index) and in somatic and proprioceptive sensitivity, facial symmetry and electrophysiological responses.
These results highlight the central role of the physiotherapist in the management of facial palsy.
Little clinical literature is still available on physiotherapy field about the treatment of 7nc injuries. Minimal is that in which the specific physiotherapy techniques of intervention are described.
The work of colleagues who have indicated therapeutic conducts is very important. An interdisciplinary contribution that can give comfort to the active participation of the subject and enhancement to the physiotherapist’s knowledge and skills can be very useful.
1 Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngol. 2008;265(7):743–752
2 Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002;(549):4–30.
3 Cavallaro F, Portaro S, Pintaudi T, Ceccio M, Alito A. Remote Cognitive Therapeutic Exercise in Facial Nerve Palsy Rehabilitation: Pandemic Tips and Tricks. Innov Clin Neurosci. 2023 Jan-Mar;20(1-3):10-12. PMID: 37122569; PMCID: PMC10132273.
