Peripheral Facial Palsy Research Articles

Proprioceptive Neuromuscular Facilitation and/or Electrical Stimulation in Patients with Peripheral Facial Paralysis: A Systematic Review

Background: Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20–30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, and, in certain cases, surgery. Proprioceptive neuromuscular facilitation (PNF) techniques and electrical stimulation have been shown to be significant for recovery. Although PFP has a high recovery rate, up to 40% of patients may experience permanent sequelae. Objective: to assess the efficacy of treatment based on electrical stimulation and/or PNF in patients affected by PFP. Methods: A systematic search was conducted across six databases (PubMed, Medline, SportDiscus, CINAHL, Scopus, and Web of Science) in November 2024. Randomized controlled trials were included. Results: Fourteen articles were analyzed, applying PNF and/or electrical stimulation methods, pharmacological treatment, low-level laser treatment, subcutaneous collagen injections, and physiotherapy protocols involving facial expression exercises, yielding evidence for the variables assessed. Conclusions: PNF and/or electrical stimulation treatment in patients with PFP can be effective when employed early with appropriate parameters, showing promising results in improving quality of life, facial movement quality, and CMAP and reducing both the incidence and degree of synkinesis.

Update on Medical Management of Acute Peripheral Facial Palsy

Acute facial nerve palsy, particularly Bell’s palsy, is a common neurological disorder with an annual incidence of 20-30 cases per 100,000 individuals. It is characterized by sudden or gradual facial muscle palsy and is caused by viral reactivation, inflammation, or ischemia of the facial nerve. Prognosis varies widely, depending on the severity of nerve damage and timeliness of the intervention. Steroid therapy remains the cornerstone of Bell’s palsy treatment because it reduces inflammation and facilitates recovery. Early administration, preferably within 72 hours of symptom onset, considerably improves outcomes. However, the efficacy of combination therapy remains controversial. Current guidelines recommend oral steroids as the primary treatment for Bell’s palsy and suggest the selective use of antiviral agents in severe cases or when viral involvement is strongly suspected. For severe facial palsy, such as Ramsay Hunt syndrome or varicella-zoster virus-induced cases, combination therapy may improve outcomes and reduce sequelae; however, high-quality evidence is limited. Steroid therapy is the main treatment of Bell’s palsy and antiviral therapy can be added in severe cases to improve prognosis. Additional research is required to develop standardized guidelines, concerning the use of antiviral therapies in conjunction with steroids.

COMPARATIVE EFFECT OF MIME THERAPY WITH SENSORY EXERCISES VERSUS CONVENTIONAL THERAPY AMONG BELLS PALSY PATIENTS

Background: Bell’s palsy is an acute peripheral facial paralysis involving the seventh cranial nerve, often presenting with facial asymmetry and loss of motor function. Rehabilitation is essential for restoring function, with interventions ranging from conventional physiotherapy to advanced therapies like mime therapy combined with sensory exercises. These approaches aim to improve facial symmetry, emotional expression, and motor control, offering holistic management for patients with mild to moderate facial nerve dysfunction. Objective: To evaluate the effects of mime therapy combined with sensory exercises versus conventional physiotherapy in patients with Bell’s palsy. Methods: This randomized clinical trial included 40 patients aged 18 to 65 years, recruited from Jinnah Hospital and Mayo Hospital, Lahore, using purposive sampling. Participants had unilateral facial nerve dysfunction classified as Grades II-IV on the House-Brackmann scale, with symptoms lasting less than six months. Patients with severe dysfunction (Grades V-VI) or comorbid neurological disorders were excluded. Group A received mime therapy combined with sensory exercises, while Group B underwent conventional physiotherapy. Both groups received therapy for ten weeks, with four sessions per week. Facial function was assessed pre- and post-treatment using the Sunnybrook Score and the House-Brackmann grading system. Data analysis was performed using SPSS version 22. Results: Group A demonstrated a significant improvement in Sunnybrook scores, increasing from 46.0 ± 5.0 to 70.2 ± 6.5 (p = 0.015), with a paired difference of 24.2 ± 3.0 (p < 0.001). Group B showed moderate improvement in House-Brackmann grades, increasing from 45.0 ± 4.8 to 60.1 ± 6.2 (p = 0.028), with a paired difference of 15.1 ± 2.1 (p < 0.001). Between-group analysis highlighted superior outcomes in Group A compared to Group B. Conclusion: Mime therapy combined with sensory exercises demonstrated significantly better outcomes in facial symmetry, motor function, and functional recovery compared to conventional therapy, making it a more effective rehabilitation approach for Bell’s palsy.

The value of MR neuroimaging in image evaluation of facial neuritis

Objective:To exploring the value of MR neuroimaging for quantitative assessment of the facial nerve and peripheral lymph nodes in patients with acute peripheral facial paralysis. Methods:Based on a prospective experimental design, 32 patients with idiopathic peripheral facial palsy were enrolled in the experiment. Based on MR neuroimaging technology, MR high-resolution thin-layer images of bilateral facial nerves were acquired. The diameters of different segments of the bilateral facial nerve were measured, including the labyrinthine segment, the geniculate ganglion, the horizontal segment, the vertical segment, the stem-mammary foramen segment, the trunk of the parotid segment, the temporal trunk, and the cervical trunk, as well as the quantitative indicators of peri-auricular and parotid lymph nodes（number, length and diameter of the largest lymph nodes）. Differences in quantitative indices of nerve diameter and peripheral lymph nodes between the paraplegic and healthy sides were compared using the paired t-test and Wilcoxon signed rank test. Results:The diameter of geniculate ganglion, mastoid foramen stem, parotid main trunk, temporal facial trunk, and cervical facial trunk were notably increased on the facial paralysis side compared to the contralateral side（P<0.05）. However, no significant differences were observed in the diameter of labyrinthine segment, horizontal segment, or vertical segment compared to the contralateral side. There were significantly more periauricular lymph nodes on the facial paralysis side than the contralateral side（P=0.001）. Conclusion:MR neuroimaging enables the quantitative assessment of structural changes in the facial nerve of patients with acute peripheral facial paralysis, demonstrating nerve enlargement in the geniculate ganglion, stylomastoid foramen segment, main trunk of the parotid segment, temporal facial trunk, and cervical facial trunk. Additionally, an increased number of periauricular lymph nodes is observed on the affected side. These findings may aid clinicians in assessing the efficacy of treatments and predict the prognosis of these patients.

Eight and a Half Syndrome with negative imaging

The eight and a half syndrome is a clinical condition characterized by the combination of one and a half syndrome with ipsilateral peripheral facial nerve palsy.

Challenges in the Management of Giant Carcinoma Ex-Pleiomorphic Adenoma of the Parotid Gland in a Single Tertiary Center.

Background and Objectives: Carcinoma ex-pleiomorphic adenoma (CXPA) is a carcinoma derived from a primary or recurrent pleiomorphic adenoma. Microscopically, non-invasive CXPA (intracapsular and carcinoma in situ), minimally invasive CXPA (extracapsular invasion less than 1.5 mm), and invasive CXPA (extracapsular invasion more than 1.5 mm) are described. Materials and Methods: We performed a retrospective clinical study over the period of 2009-2023 in patients admitted to the ENT Department of the Bucharest University Emergency Hospital. Results: In the studied group, there was a net male predominance of 2.5:1. The tumor evolution until presentation was 6.64 years on average, with values between 2 and 20 years. The reasons for presenting to our department included a sudden increase in size in eleven cases (78.57%), pain in nine cases (64.29%), peripheral facial paralysis in eight cases (57.14%), skin invasion/ulceration in five cases (35.71%), and massive tumor hemorrhage in one case (7.14%). There were histopathological results on paraffin of myoepithelial CXPA in four cases (28.57%), of high-grade CXPA (salivary duct, secretory) in eight cases (57.14%), and of squamous CXPA in two cases (14.29%). The patients with unfavorable evolution showed the following characteristics: a tumor diameter over 11 cm (four cases), integument invasion (four cases), perivascular invasion at HP exam (six cases), perineural invasion at HP exam (six cases), and invasion of the ganglion (three N3b cases and two N1 cases). Conclusions: CXPA is a neoplasia that, when associated with large tumor volumes or peripheral facial paralysis in particular, is a challenge for both the doctor and patient.

Pediatric Bell’s Palsy: Prognostic Factors, Management Strategy, and Treatment Outcomes

Background/Objectives: Bell’s palsy (BP) is a neurological disorder characterized by sudden unilateral peripheral facial paralysis. The etiology in children remains largely unknown, and standardized management strategies are lacking. The aim of this retrospective cohort study is to evaluate clinical features, laboratory markers, and therapeutic options associated with recovery to identify potential prognostic factors and validate therapeutic strategies, with a particular focus on the role of corticosteroids and vitamin supplementation. Methods: A retrospective cohort study was conducted on 88 children (aged &lt; 18 years) diagnosed with BP at a single tertiary care center between 2010 and 2023. Clinical data, including House–Brackmann (HB) scores, were collected at baseline and at a two-month follow-up. Statistical analysis was performed to assess the associations between demographic, clinical, and laboratory parameters with recovery outcomes. Prednisone and vitamin supplementation were administered at the discretion of the treating pediatrician. Results: In total, 81.8% of patients achieved complete recovery at 2-month follow-up (HB grade 1). No significant associations were found between recovery and gender, age, side of paralysis, initial HB grade, or laboratory markers. However, the use of prednisone was associated with a higher rate of incomplete recovery (p = 0.024), with higher doses correlating with poorer outcomes (p = 0.022). Vitamin supplementation showed no significant impact. Conclusions: Our findings suggest that corticosteroid therapy may not be a disease-modifying factor that ultimately influences outcomes in pediatric BP. Further large-scale studies are needed to define evidence-based protocols for managing pediatric BP.

Exploring the Regularity of Acupoint Selection in Acupuncture Treatment for Peripheral Facial Paralysis

Objective: To explore the regularity of acupoint selection in acupuncture treatment for peripheral facial paralysis. Methods: Research was conducted on the etiology and pathogenesis of facial neuritis from both traditional Chinese and Western medicine perspectives, as well as on the acupoint selection based on TCM syndrome differentiation and Western anatomical aspects. The significance of acupoint selection in different stages of peripheral facial paralysis treatment and the timing of acupuncture were summarized. Conclusion: Peripheral facial paralysis is a common clinical disease and is one of the indications suitable for acupuncture treatment. The use of a staged treatment approach, combined with the selection of acupuncture prescriptions and reinforcing and reducing techniques, has a significant effect on improving the symptoms of peripheral facial paralysis, with a predominant focus on improving facial paralysis symptoms.

Severe postherpetic neuralgia and facial paralysis in the oral and periauricular regions managed with acupuncture and electroacupuncture: a case report

Postherpetic neuralgia (PHN) is a severe and persistent pain condition following herpes zoster infection. This case report details the analgesic effects of acupuncture combined with electroacupuncture in a 66-year-old male patient presenting with PHN and peripheral facial paralysis, who showed limited response to conventional treatment with corticosteroids and antiviral medications. Following a comprehensive treatment protocol, including pricking-cupping bloodletting, and targeted acupuncture, the patient experienced significant pain relief and improved facial nerve function. This report highlights the potential of traditional Chinese medicine (TCM) in managing PHN, with sustained improvement observed over a one-year follow-up period.

Una paralisi del nervo facciale che ricorre

The paper describes the case of a 16-month-old girl with suspected neurofibromatosis I who was evaluated for recurrent episodes of peripheral facial nerve palsy and severe hypertension (160/110 mmHg). Tests revealed bilateral renal artery stenosis, treated with stenting and antihypertensive therapy. The case highlights that recurrent facial nerve palsy warrants detailed investigations, including blood pressure monitoring, as hypertension can be an underlying cause.

Systematic evaluation and meta-analysis of the efficacy of Jingjin acupuncture therapy in the treatment of peripheral facial palsy

Systematic evaluation and meta-analysis of the efficacy of Jingjin acupuncture therapy in the treatment of peripheral facial palsy

Reliability of Bi- dimensional System of facial movement analysis in patients with Peripheral facial palsy.

BACKGROUND -Peripheral facial palsy (PFP) is a condition that substantially alters facial function and has a noticeable impact on appearance. Precise evaluation of the level of functioning is required for objectivity in diagnosis of facial function and monitoring clinical changes while planning and evaluating therapeutic interventions for patients with PFP. OBJECTIVE – The present study was conducted with an objective to find out the reliability and internal consistency of the Kinovea software based bi-dimensional tool in objectively evaluating Peripheral facial palsy. METHODS- 40 Patients who were diagnosed with peripheral Facial palsy were categorized on stage of House Brackmann facial nerve grading scale. Landmarks were placed on face and image was captured in resting facial symmetry and video recording of different facial expressions like closing of eye, raising of eyebrows and smiling was performed by two different examiners. The data was processed by Kinovea software to measure different facial angles. RESULTS -The intra-rater reliability (re-test reliability) for the measurement of the facial angles using Kinovea software at rest and movement analysis on both the affected and nonaffected sides was excellent (Rest-ICC-0.94, α&gt;0.95)(Movement- ICC-0.92, α&gt;0.98).The reliability between raters on analysis at rest and movement in both the affected and non-affected side were also excellent (Rest-ICC-&gt;0.96, α&gt;0.96), (Movement-ICC&gt;0.86, α&gt;0.87). CONCLUSION -Two-dimensional motion analysis system using Kinovea software can be considered as a reliable method for the assessment of unilateral Peripheral Facial Palsy and can be used extensively to detect deviation in facial angles in resting and movement.

Evaluation of the Efficacy of the Combined Therapy of Botulinum Toxin and Hyaluronic Acid Compared to Conservative Intervention in the Treatment of Chronic Peripheral Facial Paralysis of Oncologic Etiology.

Neoplasms in the head and neck often lead to peripheral facial paralysis (PFP), impacting facial expression and causing psychological distress. Standard treatments involve physiotherapy, but botulinum toxin type A (BTA) and hyaluronic acid (HA) injections have shown promise in promoting facial symmetry. To assess the effectiveness of combined BTA and HA intervention in PFP patients, comparing it to conventional treatment (physiotherapy). A single-blind, randomized clinical trial at Hospital de Amor de Barretos included 18 patients, with the control group receiving standard therapy and the combined therapy (CT) group receiving BTA and HA. Evaluations utilized the Sunnybrook facial grading scale (SFGS) and Psychosocial Facial Asymmetry Scale (EPAF) questionnaires, along with photographic analysis. CT significantly improved facial symmetry and psychosocial aspects compared to the control group. The SFGS scores increased by 27 points in CT versus 3 points in the control group, while EPAF scores decreased by 16 points in CT and increased by 1 point in the control group. Photographic analysis showed improved dynamic smiles in CT patients. Functional gains were more evident at 30 days, with continued improvement over four months. Psychosocial scores increased throughout the study. Only two CT patients reported transient issues with drinking and chewing. The study suggests the positive impact of combined therapy on psychosocial and functional aspects, emphasizing the need for further robust research to determine its therapeutic potential. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An Atypical Ramsay-Hunt Syndrome: Case Report

After the initial infection, which manifests as varicella, the varicella-zoster virus (VZV) remains dormant in the sensory nerve ganglia. It reactivates in elderly people or in immunocompromised patients. When this reactivation involves the geniculate ganglion, it typically causes the Ramsay-Hunt syndrome manifesting as shingles in the Hunt’s zone which includes the eardrum, the external auditory canal and the cavum conchae, as well as a peripheral facial nerve palsy, earache and sensitivity or sensorial disturbances of the nearby cranial ans spinal nerves. Our case describes a 40-year-old patient who developed an atypical Ramsay-Hunt syndrome associating only peripheral facial nerve paralysis and a herpetiform vesiculopustular rash in the retroauricular area, with no otologic, vestibular or sensory signs. In fact, there are anastomoses between the different cranial nerve fibers and ganglia with the spinal nerves and ganglia, which may explain the occurrence of herpes zoster in the C2 dermatome with peripheral facial nerve palsy.

Clinical and Therapeutic Features of Herpes Zoster Oticus: A Case Report

Ear shingles, also called herpes zoster oticus or Sicard syndrome, are a viral infection of the outer, middle and/or inner ear due to varicella zoster virus (VZV). Patients with ear involvement associated with facial palsy are clinically diagnosed with Ramsay-Hunt´s syndrome. We here report the case of a 22-year-old patient with herpes zoster oticus associated with peripheral facial palsy, Associated with other signs such as tinnitus, peripheral rotational vertigo, and hypoacusis. The objective of this study is to report our experience in the treatment of sicard syndrome and investigate the various clinical, para-clinical and evolutionary features of herpes zoster oticus and the therapeutic approaches.

Laser interstitial thermal therapy for hypothalamic-hamartoma-related epilepsy: the long-term cognitive outcome of the first pediatric case in Europe.

Laser interstitial thermal therapy (LITT) is a minimally invasive surgical treatment for drug-resistant, focal epilepsies. With MRI guidance, LITT can also be used to treat hypothalamic hamartoma. Here, we report on the first European case of LITT for hypothalamic hamartoma. No complication occurred except a transitory peripheral facial paralysis. The short- and long term outcomes (for both epilepsy and cognitive development) were excellent.

Efficacy analysis of electroacupuncture plus TDP in the treatment of peripheral facial paralysis: a systematic review and meta-analysis.

This study intends to carry out a systematic review and meta-analysis of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis. CNKI, VIP, Wanfang, PubMed, Embase and Cochrane databases were searched for literatures on randomized or quasi-randomized controlled trials of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis, and the references of the included studies were searched. Meta-analysis was performed using Stata15.0 software after risk of bias, quality assessment, and data extraction of the included articles by two reviewers independently. Fifteen articles were finally included, with approximately 1,568 participants (920 in the treatment group and 648 in the control group). Meta-analysis showed that the effective rate of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis was not significantly different from other treatment methods ([RR = 1.05, 95%CI (0.97, 1.12), p = 0.226]), and the recovery rate was better than other treatment methods ([RR = 1.14, 95%CI (1.05, 1.24), p = 0.002]). Subgroup analysis showed that when stratified by the inclusion of minors in the study population, it was observed that in studies including minors, the combination of electroacupuncture and TDP therapy demonstrated superior efficacy in treating peripheral facial paralysis compared to other therapeutic modalities [OR = 1.14, 95% CI (1.03, 1.25), p = 0.011]. Conversely, in studies where the population comprised solely adults, no significant difference was found between the combination therapy and other treatments [OR = 1.15, 95% CI (0.99, 1.33), p = 0.059]; whether electroacupuncture alone or other treatment methods, the recovery rate of electroacupuncture combined with TDP in the treatment of peripheral facial paralysis was better than other methods. Electroacupuncture combined with TDP is superior to other treatment methods in the treatment of peripheral facial paralysis.

Study protocol for a randomized trial comparing two electroacupuncture waveforms for different severity groups of Bell palsy.

Bell palsy (BP) is the most common cause of acute peripheral facial palsy which leads to functional and esthetic disturbances in patients and has a negative influence on daily living. Electroacupuncture (EA) has been considered an alternative treatment for improving facial function in patients with BP. However, there is no agreement on the preferred waveform type of the EA for treating BP. This is a study protocol for a pilot randomized, two-arm, three-center, clinical trial at the Third Affiliated hospital of Zhejiang Chinese Medical University, the First Affiliated hospital of Zhejiang Chinese Medical University, and the Hangzhou First People's Hospital. The trial began in November 2023 and is expected to end in December 2025. Sixty patients with BP whose electroneurography (ENoG) value is at least 20% and 60 patients with BP whose ENoG value is less than 20% will be randomly assigned to the low frequency continuous waveform group or the intermittent waveform group in a 1:1 ratio. Participants will receive 4 weeks of EA treatment and clinical assessments. The primary outcome is the change from baseline score of the Facial Nerve Grading System 2.0. The secondary outcomes include the change from baseline score of the Sunnybrook grading scale and the change from baseline amplitude of the compound muscle action potential of the affected side in the ENoG tests. This is the first study protocol to compare the treatment effect and safety of EA with low frequency continuous waveform and intermittent waveform for different severity groups of BP. This study will contribute to subsequent studies for exploring optimal EA parameters for BP treatment. ClinicalTrials.gov, NCT06063954.

Efficacy of electrical stimulation of the zygomaticus muscle in complete facial paralysis: evidence from facial grading and automated image analysis.

Surface Functional Electrical Stimulation (FES) is a well-studied intervention for multiple muscular disorders. However, it is still controversially discussed as a complementary therapy for complete facial paralysis. The aim of this intervention is to test a daily home-based ES concept as a pilot study regarding safety, feasibility, and effects on facial functionality and symmetry. In a prospective single-centre pilot study, 10 patients (median 61 years, denervation 130 d) with complete peripheral facial paralysis performed home-based FES of the affected lateral mouth region Stimulation parameters, facial paralysis scores and standardised photographs were assessed in monthly follow-ups. No serious adverse events appeared. Stimulation parameters could be constantly increased indicating effective muscle training while subjectively perceived functionality of the face improved. Thus, smile angle of the paralysed side improved as well. FES is a safe therapy model for application in facial nerve paralysis patients. A feasible stimulation protocol could be applied, which improved the functionality and symmetry of the stimulated facial region. A future controlled, randomised and double-blind follow-up study is needed to investigate these initial results in a further evolved replicable setting.

Deceleration of denervated facial muscle atrophy through functional electrical stimulation: a sonographic quantification in patients with facial nerve paralysis.

Functional Electrical Stimulation (FES) is an established intervention for a range of muscular and neurological disorders that has already been studied in numerous publications. However, its application to Peripheral Facial nerve Paralysis (PFP) still needs to be sufficiently investigated. As the first approach known to the authors, this study examines the effect of FES on the facial muscles in complete PFP using ultrasonography as a means of observation. In a prospective single-center observational pilot study, ten patients with complete PFP, confirmed by needle-electromyography (EMG), performed FES of the affected lateral mouth region at home twice daily for 20 minutes. The facial muscles' Cross-Sectional Area (CSA) was regularly assessed using sonographic quantification. While the CSA of most non-stimulated muscles decreased considerably during ongoing paralysis, a significant CSA increase of the Zygomaticus Muscle (ZYG), which was regularly subjected to FES, could be demonstrated. FES can halt the atrophy of denervated ZYG and potentially other facial muscles. Further investigations with a more significant patient collective are recommended. From now on, FES could be established as an additive method in the non-invasive treatment of PFP.