Facial Palsy

Physiotherapy Treatment for Facial Palsy in Kingston

Assessment. Treatment. Management. Discover if Facial Palsy care can help you.

What is Facial Palsy?

Facial Palsy is a weakening or paralysis of facial muscles due to damage to the Facial Nerve, usually affecting one side of the face.  Our face identifies who we are, and our facial expressions communicate our emotions and intentions. However, a Facial Palsy is not just a cosmetic problem. It can have devastating physical and emotional consequences, affecting facial expression & communication, eye closure and eye health, dental health, eating, speech and hearing. Bell’s Palsy is the most commonly diagnosed Facial Palsy, but there are other causes of Facial Palsy.

Can Facial Palsy be treated?

A Facial Nerve rehabilitation program provided by a Physiotherapist specifically trained in Facial Nerve Palsy assessment and treatment will help maximize the recovery of a damaged Facial Nerve. The comprehensive evaluation of facial movements and muscles, education regarding Facial Nerve function, and a customized neuromuscular training program will promote facial symmetry and recovery of balanced movement.  This article provides accurate, detailed information about Facial Palsy and what can be done.


The Facial Nerve starts in the brain, leaving the skull just in front of the ear on either side of our face, where it divides into five branches that supply the muscles of the face.  The Facial Nerve also controls tear and saliva production, the sense of taste and a small muscle in the ear (stapedius) that dampens vibration to protect us from loud sounds. The severity of a facial paralysis depends on the location of the injury along the nerve pathway, and how much nerve damage has occurred.

Injury to the Facial Nerve most frequently occurs where it exits the skull. This will result in all five branches of the nerve being affected. Recovery depends on the severity of the damage and can take from a few minutes to years.  Sometimes, recovery is only partial.

Not all Facial Palsies are due to Bell’s Palsy - a common diagnosis of exclusion when other causes are ruled out.

Causes of facial palsy include:

  • Viral and Bacterial infections: e.g. Ramsey Hunt Syndrome (shingles virus) or Lyme Disease (bacterial)
  • Neurological conditions: e.g. Guillain Barré Syndrome
  • Traumatic injuries:fractures or cuts to the skull or face
  • Surgical trauma: e.g. damage during removal of tumour (Acoustic Neuroma or parotid gland tumour)

Facial Nerve Palsy usually affects only one side of the face and does not cause weakness elsewhere – the exception is Guillain Barré Syndrome. After a Facial Nerve palsy, facial muscles may be weak and floppy, or short and tight. Abnormal movement patterns may develop due to synkinesis, which is unwanted involuntary muscular movement occurring with voluntary movements.

  1. Forehead and Eye:
    • The inability to blink or close our eyes fully can result in dry eye, potentially causing damage to the eye. Moisture in the eye is important for eye health and vision. Dry eyes can cause vision to become blurred. Without full eye closure some aspects of life are much more difficult such as showering and sleeping. Minor surgical procedures can be done to allow the eyelid to close and to protect the eye from dryness. If eye closure is a problem, regular use of eye drops and ointments are prescribed.
    • Light sensitivity
    • Loss of forehead wrinkles, droopy eyebrow
  2. Ear and Nose:
    • Facial Nerve damage alone does not typically cause pain. However, there may be pain around the ear if the Facial Nerve damage is caused by Ramsay Hunt Syndrome (shingles virus)
    • Hearing loss or increased sensitivity to loud noise
    • Runny or stuffy nose
    • Inability to flare nostril or wrinkle the nose
  3. Mouth:
    • Facial expressions are important for non-verbal communication and many expressions are used unconsciously. Since smiling, scowling, winking and pouting are difficult with a facial palsy, communication can be challenging. People with a facial palsy may be self-conscious and avoid smiling to try and hide their asymmetry which can give the wrong impression to others
    • Corner of the mouth may pull up, out or down
    • Inability to smile on affected side, to puff cheeks, whistle or blow
    • Difficulty eating and drinking on the affected side due to the weakness of the cheek and poor lip seal. It can be challenging to keep food and drink in the mouth while chewing. Often there is a tendency to bite the inside of the cheek or lip.
    • Dental problems can occur due to excessive or reduced salivation and altered sense of taste. Saliva is important to protect the teeth and gums from decay and disease so reduced saliva production can make teeth more vulnerable to decay. Food can pocket in cheeks resulting in dental decay and gum disease. Facial Nerve palsy can make brushing teeth more difficult and affect how well dentures fit.
  4. Synkinesis:
    • As nerve recovery occurs, Synkinesis will develop. Synkinesis results from nerve regeneration along incorrect pathways after a Facial Nerve injury. The affected muscles have to be re-taught when to move and when to stay relaxed.

Always consult a physician as soon as possible after onset of a facial palsy to confirm diagnosis. Depending on the cause of your facial paralysis, you may be given corticosteroids to reduce the inflammation and swelling of the Facial Nerve. If the facial paralysis is due to a virus (e.g. Ramsay Hunt) anti-viral medications may also be given and should be administered within 72 hours of onset to minimize nerve damage.


Early assessment and regular follow-up are important to ensure that facial rehabilitation will start at the optimal time. However, changes in facial movement patterns and symmetry can occur for many months and even years after onset. Even if you have a longstanding facial paralysis, a Physiotherapy consultation can be helpful.

A Neuromuscular Facial Nerve Rehabilitation Program should be provided by a Physiotherapist specifically trained in Facial Nerve palsy assessment and treatment.  The focus of the program will depend on the cause of the facial palsy, how long you have had the facial palsy, the type of damage to the Facial Nerve and the stage of recovery you have reached. Assessment includes evaluation of the face at rest, and of normal and abnormal movements of all facial muscles. Advice will be given about how to protect your eye from damage if eye closure is an issue, since maintaining the health of the eye is extremely important. Very specific exercises and self-management strategies will be prescribed. Facial therapy may continue for many months as your Facial Nerve recovers.

Key features of a Neuromuscular Facial Rehabilitation Program are:

  1. Gentle movement exercises carried out slowly and carefully – too much force exerted when trying to move weak facial muscles can result in increased tightness and undesirable involuntary movements
  2. Regular, daily exercises in order to make the most of your recovery
  3. Ongoing reassessment and adjustment of the program as necessary as changes and improvements occur

Best Health Physiotherapy has a physiotherapist with training and expertise specific to the assessment and treatment of Facial Palsy. Contact us to find out more or see if treatment can help you.

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