Facial Exercise Therapy as a Rehabilitation Strategy for Bell’s Palsy: A Case Report

Abstract

Background: Bell’s palsy (BP) is the most common cause of acute peripheral facial nerve paralysis, characterized by a rapid onset of unilateral lower motor neuron facial weakness of idiopathic origin. It accounts for nearly 60–75% of all cases of facial paralysis and has an annual incidence ranging from 13 to 107 per 100,000 persons. Although the prognosis is often favorable with medical management, a significant proportion of patients experience persistent facial weakness, synkinesis, or psychosocial distress. Facial exercise therapy has been increasingly recognized as a valuable adjunct in rehabilitation, aiming to restore symmetry, strength, and neuromuscular control while minimizing long-term complications.

Case Presentation: A 62-year-old male, retired advocate, with a history of hypertension presented with sudden-onset right-sided facial paralysis consistent with Bell’s palsy (House-Brackmann Grade IV). The patient reported difficulty in eye closure, mastication, and speech, along with psychological distress due to facial asymmetry and social withdrawal. Clinical findings included drooping of the right forehead, eyebrow, and mouth corner, impaired eyelid closure, drooling, tinnitus, and difficulty in eating and drinking.

Intervention: A six-week rehabilitation protocol was designed, consisting of five sessions per week, 45 minutes per session. The phased intervention included facial massage, superficial heat, electrical muscle stimulation (interrupted galvanic and faradic modes), mirror therapy, and progressive facial exercise therapy (including active, resisted, and stretching exercises). Exercises emphasized controlled, repetitive movements such as smiling, puckering, nasal flaring, eye closure, and vowel articulation, performed with mirror feedback to enhance neuromuscular control.

Outcomes: At re-evaluation, the patient demonstrated significant improvements across validated outcome measures. The House-Brackmann grade improved from IV to II, the Facial Nerve Grading System 2.0 (FNGS 2.0) score improved from 15–19 to 5–9, and the Sunnybrook Facial Grading System (SFGS) score increased from 25 to 65. Functionally, the patient regained the ability to close the eye, perform symmetric facial expressions, and eat and drink with greater ease. Psychologically, the patient reported enhanced confidence, improved participation in social activities, and relief from distress related to facial aesthetics.

Conclusion: Facial exercise therapy is a safe, low-cost, and effective intervention for the rehabilitation of Bell’s palsy, producing significant improvements in facial function and quality of life. This case underscores the need for early physiotherapy referral and supports further research through randomized controlled trials to establish standardized rehabilitation protocols.