Facial muscles are unique in the human body. They move the facial skin in multiple directions to produce a wide range of movement patterns that enable nonverbal communications, eye closure, and oral motor functions (1).

Facial Palsy is the paralysis of seventh cranial nerve. The seventh cranial nerve can be affected due to various causes, most common is due to a viral inflammation. This inflammation in the nerve causes paralysis of one whole side of the facial muscles, commonly known as Bell’s Palsy.

Facial palsy not only affects the basic functions of face but other aspects of life as well. It can be both socially and psychologically distressing. One of the complication of delayed recovery is Synkinesis; uncoordinated, inappropriate movement of the facial muscles.

Facial Neuromuscular retraining (fNMR) offers a non-surgical approach to rehabilitation for restoring and refining functional facial movement and expression in patients with Synkinesis. fNMR uses selective neuromotor training to normalize resting tone, facilitate symmetrical movement, and control aberrant gross motor activity (1).

Various causes of peripheral Facial Nerve Palsy:

1. Bell’s Palsy - most common

2. Ramsay Hunt Syndrome

3. Lyme’s disease

4. Acoustic neuroma/ vestibular & Facial Schwannomas

5. Parotid Tumors

6. Eclampsia/ 3rd Trimester pregnancy

7. Trauma

8. Iatrogenic: like dental surgery, face lift

9. Congenital Facial palsies

10. Other syndromes like Melkersson-Rosenthal syndrome

Reference:

1. Diels, HJ. Facial Neuromuscular Retraining for Synkinesis. In Azizzadeh B & Nduka C, ed. Management of Post-Facial Paralysis Synkinesis; Elsevier; 2022:75-90.