Physical therapy for peripheral facial palsy: A systematic review and meta-analysis

Auris Nasus Larynx. 2024 Feb;51(1):154-160. doi: 10.1016/j.anl.2023.04.007. Epub 2023 May 4.


Objective: This study aimed to reveal the efficacy of physical therapy for patients with peripheral facial palsy.

Methods: A literature search was conducted using PubMed, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trials comparing the physical therapy versus placebo/non-treatment for peripheral facial palsy such as Bell's palsy, Ramsay Hunt syndrome, and traumatic facial palsy were included for meta-analysis. The primary outcome was non-recovery at the end of the follow-up. Non-recovery was defined according to the authors' definition. The secondary outcomes were the composite score of the Sunnybrook facial grading system and sequelae (presence of synkinesis or hemifacial spasm) at the end of the follow-up. Data was analyzed using Review Manager software and pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated.

Results: Seven randomized controlled trials met the eligible criteria. The data on non-recovery from four studies was obtained and included 418 participants in the meta-analysis. Physical therapy might reduce non-recovery (RR = 0.51 [95% CI = 0.31-0.83], low quality). Pooling the data of composite score of the Sunnybrook facial grading system from three studies (166 participants) revealed that physical therapy might increase the composite scores (MD = 12.1 [95% CI = 3.11-21.0], low quality). Moreover, we obtained data on sequelae from two articles (179 participants). The evidence was very uncertain about the effect of physical therapy on reduction of sequelae (RR = 0.64 [95% CI = 0.07-5.95], very low quality).

Conclusion: The evidence suggested that physical therapy reduces non-recovery in patients with peripheral facial palsy and improves the composite score of the Sunnybrook facial grading system, whereas the efficacy of physical therapy in reducing sequelae remained uncertain. The included studies had high risk of bias, imprecision, or inconsistency; therefore, the certainty of evidence was low or very low. Further well-designed randomized controlled trials are needed to confirm its efficacy.

Keywords: Bell's palsy; Facial palsy; Physical therapy; Ramsay Hunt syndrome; Rehabilitation.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Bell Palsy* / drug therapy
  • Drug Therapy, Combination
  • Facial Paralysis* / drug therapy
  • Humans
  • Physical Therapy Modalities


  • Anti-Inflammatory Agents