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  • Writer's pictureRobin R Varghese, PT.

Did facial palsy just steal your smile??? Let us handle the culprit right away.

Facial palsy is caused by damage to the facial nerve (the 7th cranial nerve) that supplies the muscles of the face.


There are two types based on the location of the casual pathology:

1. Central facial palsy

· Due to damage above the facial nucleus

2. Peripheral facial palsy

· Due to damage at or below the facial nucleus


Upper motor neuron causes are:

Intracranial tumor



Lower motor neuron causes are:






Rare causes like Multiple Sclerosis, Guillain-Barre Syndrome, Otitis media, Neurosarcoidosis, etc

Risk factors:

Diabetes, Pregnancy, Ear infection, Upper Respiratory tract infection and Obesity.

Clinical presentation

  • Paralysis of the muscles supplied by the facial nerve presents on the affected side of the face as follows:

  • Inability to close the eye

  • Lack of tear production

  • Inability to move the lips (e.g. into a smile, pucker)

  • At rest, the affected side of the face may "droop" except while the patient is in synkinesis. For example, voluntary movement of the mouth may result in the closure of the eye”

  • Ectropion - i.e. the lower eyelid may droop and turn outward

  • Hyperacusis - i.e. sensitivity to sudden loud noises

  • Altered taste sensation


  • Absence of horizontal lines on the forehead on the affected side

  • Affected eye larger/more open than the unaffected one

  • Lack of blink on the affected eye

  • Altered position or absence of the naso-labial fold on the affected side

  • Position of the affected corner of the mouth lower than the other side

  • Functional defects like:

-Difficulty eating and drinking as the lack of lip seal makes it difficult to keep fluids and food in the oral cavity

-Reduced clarity of speech as the "labial consonants" (i.e. b, p, m, v, f) all require lip seal

-Dryness of the affected eye

Physical Therapy management

Apart from the medical and the surgical management, Physical therapy plays a major role in patient education and in caring for the eye in the affected side by preventing corneal ulcer, use of eye lubrication and taping techniques.

Other PT treatment includes:

  • Neuromuscular retraining (NMR)

  • Electromyography (EMG) and mirror biofeedback

  • Trophic electrical stimulation (TES)

  • Proprioceptive neuro muscular facilitation (PNF) techniques

  • Kabat technique

  • Mime therapy


  • Neuromuscular re-education techniques have been found to be effective in increasing facial range of movement and symmetry, as well as reducing / minimizing synkinesis.

  • Mime therapy can improve functionality for patients with facial palsy

  • One study found that PNF technique is more effective than conventional exercises

  • One study found PNF and the Kabat technique is more effective than no exercise

  • The effect of electrical stimulation is controversial.

At Valley Healing Hands, we provide the best Physical Therapy treatment for Facial Palsy. Our highly skilled therapists will prescribe personalized exercises to rectify your problems and will be by your side to walk you through the phase to recovery. Our patients are completely satisfied with our service. You may learn about us here and get connected to us here. Our patients love us and you too will!!!

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