Physiotherapy plays a crucial role in the management and rehabilitation of bilateral facial palsy. The primary goals of physiotherapy are to:

• Maintain muscle tone: Prevent muscle atrophy and weakness.
• Facilitate nerve regeneration: Encourage the recovery of nerve function.
• Improve facial symmetry and movement: Help regain control over facial expressions and functions.
• Prevent complications: Address issues like eye dryness and oral incompetence.
• Reduce synkinesis: Minimize unwanted movements that can occur during recovery.

Physiotherapy program for bilateral facial palsy typically includes the following components:

• Facial Muscle Exercises: These are tailored to address specific muscle weaknesses and aim to improve voluntary control, strength, and coordination. Examples include:
  • Forehead: Trying to raise eyebrows, wrinkling the forehead.
  • Eyes: Gently closing and opening eyes, squeezing eyes shut, trying to wink.
  • Nose: Wrinkling the nose, flaring nostrils.
  • Cheeks: Puffing out cheeks, retracting cheeks.
  • Mouth and Lips: Smiling, frowning, puckering lips, saying specific vowel and consonant sounds.
  • Tongue: Sticking the tongue out, moving it side to side and up and down.

These exercises are often performed in front of a mirror to provide visual feedback.

• Facial Massage: Gentle massage techniques can help to:
  • Improve blood circulation to the facial muscles.
  • Reduce muscle stiffness and tension.
  • Promote lymphatic drainage.

Common massage techniques include stroking, effleurage (light gliding movements), and gentle circular motions.

• Neuromuscular Retraining (NMR): This technique focuses on relearning facial movements by providing specific and accurate feedback. It aims to:
  • Improve coordination between different facial muscles.
  • Suppress abnormal muscle activity and synkinesis.
  • Refine movements for functional activities like speaking and eating, as well as for facial expressions.
• Electrical Stimulation (EMS): In some cases, electrical stimulation may be used to gently stimulate the facial muscles. This can help maintain muscle tone and facilitate nerve regeneration, especially in the early stages when voluntary movement is limited.
• Heat Therapy: Applying moist heat to the face can help to relieve pain and muscle tension.
• Eye Care Education: Since bilateral facial palsy can affect the ability to close the eyes properly, physiotherapists provide guidance on:
  • Using artificial tears to prevent dryness.
  • Learning techniques to manually close the eyelids.
  • Using eye patches, especially at night, to protect the eyes.
• Oral Motor Exercises: These exercises address difficulties with speech and eating by focusing on the muscles around the mouth and tongue.
• Breathing and Relaxation Exercises: These can help manage any associated anxiety or stress.