Emotional Training After Facial Nerve Palsy: Let's Smile Again!

Background: We aimed to propose Emotional training (ET) as a neurocognitive approach, based on motor imagery by stimulating the patient's perception through different stimuli on the face to treat peripheral paralysis of the facial nerve. Methods: Retrospective, observational, double-centres cohort study of 50 patients diagnosed with peripheral facial nerve palsy. Facial function was assessed through the House-Brackmann scale (HBS, the primary outcome), the Sunnybrook Facial Grading System (FGS, secondary outcome) and the Italian validated version of the Facial Disability Index (It-FDI, secondary outcome) at the beginning and the end of the rehabilitation protocol. An author blinded to the protocols did the data analysis. Results: All patients showed improvement at the end of ET (HBS: 2 (p < 0.001); FGS: 57 (p < 0.001); It-FDI: 80 (p = 0.002)), by achieving a slight dysfunction or even normal function compared to baseline (HBS: 4; FGS: 21; It-FDI: 76). A second group of 8 surgical patients treated with an already published protocol served as control. HSB and FGC did not differ between the two groups at baseline and after 20 rehabilitative sections, with similar improvements. Conclusion: ET provided significant improvements in the symmetry of the face at rest and during voluntary movements, in social function and subjectively perceived well-being. ET is an effective therapeutic proposal for patients suffering from idiopathic or iatrogenic facial nerve palsy.