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Bells Palsy, Physiotherapy treatments and facial muscle dry needling

Updated: Nov 18, 2021


By Matthew Craig, Physiotherapist USYD 2003-current

Founding Director, bounceREHAB 2005+


Figure 1: What Matt does on holidays when left home alone… his ‘painless mock up’ of physio performed dry needling to a right sided Bell’s Palsy

WHAT IT IS

In a Nutshell…… Idiopathic facial palsy, also called Bell’s palsy, is an acute disorder of the facial nerve, which may begin with symptoms of pain in the mastoid region and produce full or partial paralysis of movement of one side of the face (Adour 1982; Valença 2001).


CAUSE

Its cause is not known (Peitersen 2002). Increasing evidence suggests that the main cause of Bell’s palsy is reactivation of latent herpes simplex virus type 1 in the cranial nerve ganglia (De Diego 1999; Holland 2004; Valença 2001). How the virus damages the facial nerve is uncertain (Gilden 2004).





HOW IT OFTEN LOOKS





PREVALENCE The annual incidence of Bell’s palsy varies widely, ranging between 11.5 and 40.2 cases per 100,000 population (De Diego 1999; Peitersen 2002). There are peaks of incidence in the 30 to 50 and 60 to 70 year old age groups (Gilden 2004; Gonçalvez 1997).


PROGNOSIS Bell’s palsy has a fair prognosis without treatment (Holland 2004). According to Peitersen (Peitersen 2002), complete recovery was observed in 71% of all patients. Ninety-four per cent of patients with incomplete and 61% with complete paralysis made a complete recovery, but it is unknown if intervention with physical therapies improves outcome because the quality of the studies have been low.  BounceREHAB has however seen fantastic outcomes in the clinic.


About 23% of people with Bell’s palsy are left with either moderate to severe symptoms, such as hemifacial spasm, partial motor recovery, crocodile tears (tears upon salivation), contracture or synkinesis (involuntary twitching of the face or blinking). Recurrence occurs in about 8.3% (Valença 2001).


The prognosis depends to a great extent on the time at which recovery begins. Early commencement of recovery is associated with a good prognosis and late recovery a bad prognosis. If recovery begins within one week, 88% obtain full recovery, within one to two weeks 83% and within two to three weeks 61%. Normal taste, stapedius reflex and tearing are also associated with a significantly better prognosis than if these functions are impaired. Recovery is less likely to be satisfactory with complete rather than incomplete paralysis, with pain behind the ear and in older people (Danielidis 1999). Other poor prognostic factors include hypertension and diabetes mellitus (Gilden 2004; Peitersen 2002).



Figure 4: Facial nerve distribution and its close association with other cranial nerves and visceral functions

TREATMENTS (AND THEIR RECENT EVIDENCE)

Firstly, check out these interesting case studies. It may help to reduce your stress levels:



Evaluation of therapies is made difficult by the high rates of spontaneous and complete recovery (Peitersen 2002). This needs to be controlled for future studies. Blinding subjects and therapists in the treatment of Bell’s Palsy for the scope of physiotherapy services (exercises, acupuncture, dry needling and electrotherapy) is incredibly difficult to sham against placebos.


The treatments for Bell’s palsy are aimed at returning facial power to normal for cosmesis, competence of lip seal and protection of the cornea from drying and abrasion due to impaired lid closure and tear production. For the latter, lubricating drops are recommended during the day and a simple eye ointment at night (Adour 1982; Holland 2004; Valença 2001).


Corticosteroids & Surgery….

Recent Cochrane systematic intervention reviews demonstrate there is significant benefit from treating Bell’s palsy with corticosteroids (Salinas 2010). Some authors suggest that facial nerve decompression might be considered, although there is no data from clinical trials to support its use (Adour 2002; Gilden 2004; Grogan 2001) and a Cochrane systematic review about surgical interventions confirmed this finding (McAllister 2011). A systematic review about the efficacy of hyperbaric oxygen therapy (Holland 2008) and a overview of reviews about the Bell’s palsy treatment (Lockhart 2010b) are in development.