Physical Therapy for Iatrogenic Facial Paralysis

Abstract

acial paralysis (FP) secondary to surgery has a reported incidence of 11% to 40%. 1 Rates of iatrogenic FP vary by surgery type: oral-maxillofacial surgery is the most common (40%), followed by head and neck surgery (25%), otologic surgery (17%), and cosmetic surgery (11%). 1 For patients, FP is associated with substantial functional, emotional, and financial consequences. [2][3][4] Given its detrimental impact, iatrogenic FP is an important complication for otolaryngologists, plastic surgeons, oral surgeons, and dermatologists to manage. Most iatrogenic FP is expected to be temporary 5 and is managed by watchful waiting.Treatment options to encourage facial function recovery are varied, including medical therapy (ie, corticosteroids) and physical therapy (PT). 5 Physical therapy is advantageous because it is noninvasive and encourages patients to actively participate in their recovery. 6 However, there is a paucity of literature on the effectiveness of PT. Although a 2011 Cochrane review by Teixeira et al 7 found no high-quality evidence supporting the benefit or harm of PT for idiopathic FP, studies of PT for iatrogenic FP are limited to a few randomized controlled trials (RCTs) 5,8 and observational studies. 9 Iatrogenic FP can occur despite meticulous surgical dissection and intraoperative confirmation of facial nerve continuity likely because of local manipulation. 1 Therefore, iatrogenic FP represents a pathogenesis unique from idiopathic FP, which is often stated to result from inflammation after viral infection. 7 The primary objective of this systematic review was to investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP. Methods Study DesignThe Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) 10 guidelines were followed in this systematic IMPORTANCE Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT).OBJECTIVE To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP.LP;&-2QEVIDENCE REVIEW Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using

A Comprehensive Approach to Facial Reanimation: A Systematic Review

“…Physiotherapy may improve functional recovery and increase the quality of life and psychological well-being of patients suffering from facial palsy [ 86 , 87 , 88 ]. Numerous physiotherapy techniques for patients with facial paresis have been described and include exercise, electric stimulation, biofeedback, and neuromuscular retraining [ 89 ].…”

Comprehensive Rehabilitation of Patients with Facial Expression Asymmetry and Synkinesis with Botulinum Toxin Type A and Monofilament Mesothreads

“…Additionally, the effect of injections is short term (2-3 months). There are also known methods of surgical correction of synkinesis [12,16], but they require the excision of areas of synkinesis and hospitalization in a surgical department. This can lead to persistent weakness of facial muscles and the formation of muscle contractures [11,14].…”

Role of Electrical Stimulation Added To Conventional Therapy in Patients With Traumatic Facial Palsy

“…ES of muscle aims at preserving muscle bulk, especially in complete paralysis, and it also has a psychological benefit as the patient observes muscle contractions in his face that gives him hope for recovery from facial paralysis (16). In 2020, three studies reported the use of electrical stimulation of facial muscles for Iatrogenic Facial Paralysis (23). The case series by Choi et al (24) described three patients who achieved full recovery of facial function after treatment with physical therapy and electrical stimulation.…”