Bell’s Palsy is the most common type of Facial Palsy, however, as there are over 50 other known causes of Facial Palsy, it should not be assumed that every case is Bell’s Palsy. It is extremely important to distinguish between the different types and causes as different investigations, treatments and longer-term prognosis apply to the differing types. www.facialpalsy.org.uk 2023 

On your first appointment here in PMC Physiotherapy, you will be seen by Caitriona who is a Specialist Facial Therapist and Chartered Physiotherapist. In order to establish the exact cause and type of Facial Palsy you present with; the initial part of your appointment consists of a series of in-depth questions regarding: 

1. The onset of your symptoms. 

2. The specialities (GP, consultants, therapists, holistic practitioners) you have attended since the onset of your symptoms. Many people with Facial Palsy have a very fragmented route to finding an appropriate service to treat their Facial Palsy. A recent patient survey in the UK highlighted that many people are either not referred onwards or incorrectly referred by their GP or Emergency Department, due to a lack of awareness of where to receive treatment for Facial Palsy. This leads to delays in diagnosis, may slow recovery and certainly adds to the pschological distress that is already grossly underestimated in Facial Palsy.  www.facialpalsy.org.uk  2019 The same is true here in Ireland; some people may have attended one or multiple consultants, including ENT, Neurology, Opthamology, Plastic Surgery, etc, however, most people have not seen anyone other than a doctor in the Emergency Department or their GP since their onset of Facial Palsy. It could now be weeks or years since the onset and medical review. 

3. Any treatment or investigations you have had to date.

4. When or if you have noticed any recovery or improvement from your initial onset.  

5. Your Past Medical History and any medication you are taking.

As Facial Palsy is far greater than simply a cosmetic issue Caitriona will enquire about all the physical functional problems you are experiencing as a result of Facial Palsy.

This list includes: 

1. Issues with your eye – dry eye, tearing, gritty feeling, unable to close or open your eye fully etc. 

2. Issues with your breathing through your nose

3. Issues with hearing, either amplified or loss of hearing

4. Issues with balance or dizziness

5. Issues with eating/drinking – biting your cheek, food spilling out, drooling with certain drinks

6. Issues with speech, in particular unable to prounounce “B”, “P” etc

7. Issues with expression – as a famous person once said – our face is the gateway to our soul. 

8. Any pain, headaches or sensation of tightness in the face 

9. And although I have left this one until the end, it is one of the most overlooked aspects of Facial palsy, your mental health. At least 30% of people with Facial Palsy suffer from symptoms of depression. Developing Facial Palsy and having to adjust/manage the change in your appearance and facial function can be very distressing and disruptive to your life, and lead to changes in your mood. Interestingly, the severity of Facial Palsy is not always a good predictor of how someone’s mood can be affected. Oxford University Hospital, 2021

The next step of the appointment is getting a baseline of the facial muscles during expression. To do this a video and series of photos are taken with your consent.  

In the final step of your assessment Caitriona will palpate the muscles in your face and neck to check their flexibility, tone and whether there are any tender spots present.

Following your assessment Caitriona will discuss your bespoke treatment plan to address your individual needs. The aim of facial rehabilitation is to address the physical, functional and psychosocial problems associated with facial paralysis.

1. The treatment portion of your appointment consists of:
2. Comprehensive education regarding nerve injuries, healing and facial muscle function. 
3. Practical tips to deal with physical problems related to Facial Palsy. 
4. Demonstration of a stretching/release programme to complete at home. 
5. A guide to relearning facial movement and expression through a programme called facial Neuromuscular Retraining. 
6. A prognosis for improvement/recovery. 
7. Onward referral as required to appropriate services.

An initial Facial Palsy appointment is one and a half hours long. If possible do not wear clothing with a high neck as it is important to be able to view from the shoulders up. If you have long hair, have it tied back or clipped back off your face. You do not need to do anything further in preparation for the appointment.

If you or someone you know has Facial Palsy and wishes to address some of the issues mentioned above, please visit our website at www.pmcphysiotherapy.ie to book an appointment or contact the clinic at 018253997.