(876) Rehabilitation With vs Without Botulinum Toxin for Chronic Facial Palsy: FaCE Scale Comparison

Introduction: Chronic facial nerve palsy (FNP) often leaves synkinesis, hypertonicity/contracture, and involuntary movements, leading to persistent functional impairment and reduced social participation. We compared patient-reported outcomes between rehabilitation with versus without adjunct botulinum toxin (BTX) therapy in chronic FNP.

Methods: Single-center retrospective study of chronic FNP (duration >1 year) with residual sequelae treated from January 2015 to December 2025. Patients received BTX combined with rehabilitation (BTX group, n=10) or rehabilitation alone (control group, n=10). The Facial Clinimetric Evaluation (FaCE) Scale was assessed at baseline (t1) and follow-up (t2); in the BTX group, t1 was immediately prior to the first injection. Primary outcome was change in FaCE scores (Δ=t2−t1). Groups were compared using Welch’s t-test. Mean observation period was 20.7 months (BTX) vs 15.8 months (control).

Results: Mean age was 64.0±14.1 years (BTX) and 60.9±12.7 years (control). Females were 10/10 in the BTX group and 5/10 in the control group. Median House–Brackmann grade at t1 was 3 (IQR 2–3) in both groups. The BTX group showed greater improvement than controls in Social Function (p=0.003), Oral Function (p=0.021), Facial Movement (p=0.012), and Total Score (p=0.010). No between-group differences were observed in Facial Comfort, Eye Comfort, or Lacrimal Control (all p>0.05).

Conclusions: Rehabilitation combined with BTX improved patient-reported facial movement, oral function, and social well-being in chronic FNP. BTX may reduce social anxiety and avoidance by suppressing muscle overactivity and synkinesis, thereby decreasing involuntary facial asymmetry and improving oral motor function. Lack of improvement in Facial Comfort may reflect that chronic tightness includes not only reversible muscle overactivity but also less reversible components such as soft-tissue remodeling/fibrosis. BTX appears to be a valuable adjunct to rehabilitation to enhance functional recovery and social participation.