CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 633-641
DOI: 10.1055/s-0042-1756352
Pediatric/Craniomilofacial/Head & Neck: Original Article

Comparative Study of Multimodal Therapy in Facial Palsy Patients

1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
2   Department of Psychological Therapy, Queen Victoria Hospital, East Grinstead, United Kingdom
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
3   Department of Oculoplastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
› Author Affiliations
Funding None.


Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes.

Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale.

Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (p < 0.01), more chemodenervation episodes (p < 0.01), increased doses of botulinum toxin (p < 0.001), and having higher EGGS score (p < 0.001).

Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

Authors' Contributions

C.N.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, visualization, writing – original draft, review and editing. T.G.: Data curation, investigation, project administration, resources. K.Y.: Data curation, investigation, project administration, resources. E.J.: Data curation, investigation, project administration, resources. R.M.: Resources, supervision, validation, writing – review and editing. C.N.: Resources, supervision, validation, writing – review and editing. R.Y.K.: Conceptualization, formal analysis, methodology, resources, supervision, visualization, writing – review and editing.

Ethical Approval

This study adheres to the Strengthening The Reporting of OBservational Studies in Epidemiology (STROBE) guidelines, conforms to the Helsinki guidelines on ethics, and was registered with and approved by the institutional review team from the Research and Development Department at The Queen Victoria Hospital NHS Foundation Trust prior to being conducted (IRB No.1286).

Patient Consent

Patients gave their informed consent for their images to be shared.

Publication History

Received: 28 December 2021

Accepted: 07 July 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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