Guidelines for Treatment

Facial Rehabilitation

The aim of facial rehabilitation is to address the physical, functional and psychosocial problems associated with facial paralysis.

The speed and degree of recovery from facial palsy is dependent upon the cause and the degree of damage to the facial nerve. Other relevant comorbidities may also have an impact on the degree and rate of recovery e.g. Diabetes

Recovery

Recovery may be complete as in the majority of cases of Bell’s Palsy, to none or incomplete, when there has been a significant injury to the facial nerve. This may result in complete or persistent residual facial weakness and synkinesis.

Prognosis

Patients fall into three groups:

Group 1: Complete recovery of facial function without sequelae

Group 2: Incomplete recovery of facial motor function but no cosmetic defects apparent to the untrained eye.

Group 3: Permanent neurologic sequelae that are both clinically and cosmetically apparent.

The sooner recovery starts the less likely are the chances that sequelae will develop:

  • If movement is noted within 3 weeks then recovery is most likely to be complete
  • If recovery starts between 3 weeks and 2 months, then the outcome is usually satisfactory.
  • If recovery does not begin until 2-4 months from onset, the likelihood of incomplete recovery is high, including residual weakness and synkinesis
  • If there is no recovery by 4 months then the patient is more likely to have sequelae such as synkinesis, crocodile tears and rarely hemifacial spasm

Before starting treatment the therapist must ensure that the cause of the weakness has been established and with that, the time course and degree of expected recovery.