Beyond Recovery: Physiotherapy's Pivotal Role in Treating Synkinesis and Contracture in a Case of Severe Bell's Palsy

Bell's Palsy is an idiopathic condition that results in abrupt, unilateral facial paralysis 1. In most patients, the recovery period is complete and without consequent 1. However, a group of patients, and among them, the initial severe cases (House-Brackmann grade IV or above) ones, usually, tend to recover incompletely and develop adverse reactions 1. The common complications are synkinesis (the involuntary muscle co-contraction, e.g., the eye closing when smiling) and contracture (muscle tightening) 2. This case report describes the treatment of a 65-year-old male who came with the diagnosis of severe right-sided Bell's Palsy (House-Brackmann VI), later, able to produce synkinesis and contracture of significant degree 9. Only after the cortisone injection, he had a six-month follow-up wherein he recovered voluntary movements partially 10. A decision was made to take a multidisciplinary approach with an emphasis on the physiotherapy session 6. The personalized treatment plan consisted of Neuromuscular Retraining to focus on the isolation of movements, Manual Therapy to elongate contracted muscles, and Biofeedback to facilitate the conscious control of muscles 3,4, 5. As a matter of fact, six months later, the House-Brackmann score dropped from Grade V to Grade III and the severity of synkinesis and contracture was considerably reduced 10. In this case, the importance of specialized and patient-specific neuromuscular retraining in the treatment for long-term sequelae of complicated Bell's Palsy is emphasized 11.