Peripheral facial nerve palsy: how effective is rehabilitation?

OBJECTIVE: To review the current literature to assess the effectiveness of rehabilitation treatment for peripheral facial nerve palsy. DATA SOURCES: A review of the literature was conducted using the following database: PubMed, EMBASE, PEDro, and Scopus. All randomized or quasi randomized controlled trials, case control, cohort studies and case series greater than 6 published between 1990 and 2010 in the English language were included. STUDY SELECTION: All types of peripheral facial nerve palsy were included. We considered all the exercises or rehabilitation programs provided by a physiotherapy in outpatient or home setting and excluded trials in which a drug therapy or surgical intervention was investigated. Three reviewers independently selected the articles. DATA EXTRACTION: To rate the methodological quality of the studies the American Academy of Neurology classification of evidence for therapeutic intervention (Classes I-IV) was applied. CONCLUSION: Peripheral injury of the VIIth cranial nerve can have serious repercussions on the patient's functioning and quality of life. The recovery rate is related to the preservation of the nerve and to the cause of palsy. We obtained a third level of recommendation (level C); mime therapy could be effective to improve functional outcome in these patients. Evidence of specific treatment addressed to specific cause is lacking; likewise, no evidence is available on timing of intervention with respect to time of onset. Well-designed randomized controlled trials are required to evaluate the effect of rehabilitation in patients with facial palsy