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. 2020 Nov 1;146(11):1065-1072.
doi: 10.1001/jamaoto.2020.3049.

Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review

Nneoma S Wamkpah  1 , Latoya Jeanpierre  2 , Judith E C Lieu  1 , Drew Del Toro  3 , Laura E Simon  4 , John J Chi  5
Affiliations

Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review

Nneoma S Wamkpah et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT).

Objective: To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP.

Evidence review: Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019.

Findings: Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types.

Conclusions and relevance: Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Simon reported serving on the New England Journal of Medicine Library Advisory Board for the 1-year term beginning January 2020 (which includes a $500 stipend and annual meeting travel fees). However, because of COVID-19, the annual meeting did not occur, and travel expenses were not incurred. No other disclosures were reported.

Figures

Figure.
Figure.
PRISMA Flow Diagram of Studies in the Systematic Review
See this image and copyright information in PMC

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