The importance of mirror facial exercises in a child with Bell’s palsy: A case report

Abstract

Case Diagnosis: Bell’s palsy is a neuropathy involving the seventh cranial nerve, that, can be caused by traumatic, infective, inflammatory, and idiopathic. Presentation of Bell’s palsy in pediatric population is quite rare. Appropriate therapy must be given to prevent sequelae that affect their function, social life, and psychology.Case Description: We present a case of a six-year-old girl with Bell’s palsy. She came with five days of left facial nerve paralysis. Patient couldn’t raise her left eyebrow, unable to close her left eye completely, asymmetrical on the left nose and lip, absence of left forehead creases and nasolabial fold, and synkineses. To quantify the outcome, Facial Grading System (FGS) was calculated, and obtained score 5/100 on the first day of therapy. The patient was prescribed a course of methylprednisolone for eleven days and mecobalamine for seven days. The physical rehabilitation program was electrical stimulation and infrared therapy once a week, and Proprioceptive Neuromuscular Facilitation (PNF). On the seventh day, the FGS score was 10/100.This happened because her parents, as fulltime workers, not performed PNF appropriately and the patient couldn’t perform it independently. Therefore, patient was trained with easier facial exercises that could be performed independently in front of mirror. Then, the FGS score significantly improved, the score was 58/100 on the 13th day, and 96/100 on the 16th day.Discussion: Facial exercises in front of mirror can provide a biofeedback effect that make visual stimulation to the brain to give signals in moving the facial muscles repeatedly to prevent potential facial muscle contractures and improve facial function.Conculsion: Facial exercises in front of mirror can help patient with Bell’s Palsy to recover in shorter duration and increase muscle strength, prevent synkinesis, dyskinesis, and improve facial functionality in children with Bell’s Palsy.