Cheek Taping for Drooling in Bell's Palsy
Cheek taping is not an established or recommended intervention for managing drooling in Bell's palsy, and no evidence supports its use for this purpose.
Why Cheek Taping Is Not Recommended
The American Academy of Otolaryngology-Head and Neck Surgery guidelines for Bell's palsy management do not mention cheek taping as a treatment modality for any symptom, including drooling 1. The comprehensive guidelines address multiple aspects of Bell's palsy management but make no recommendation regarding cheek taping for oral incompetence or drooling 1.
Understanding Drooling in Bell's Palsy
Drooling occurs in Bell's palsy due to:
- Oral incompetence from paralysis of facial muscles, particularly around the mouth 1
- Drooping of the corner of the mouth on the affected side 2
- Loss of muscle tone preventing normal lip seal and saliva control 2
What IS Recommended: Evidence-Based Management
Primary Medical Treatment
- Oral corticosteroids within 72 hours of symptom onset (prednisolone 50 mg daily for 10 days OR prednisone 60 mg daily for 5 days followed by 5-day taper) to improve facial nerve recovery 1
- This addresses the underlying nerve dysfunction causing drooling 1
Expected Recovery Timeline
- Most patients begin recovery within 2-3 weeks of symptom onset 1
- Complete recovery typically occurs within 3-4 months for most patients 1
- 70% of patients with complete paralysis recover fully within 6 months 1
- Up to 94% of patients with incomplete paralysis achieve complete recovery 1, 3
Physical Therapy Considerations
- No formal recommendation exists for physical therapy in Bell's palsy due to limited evidence 1
- The AAO-HNS states that no recommendation can be made regarding physical therapy effects due to poor-quality evidence 1
- However, physical therapy may be beneficial in patients with more severe paralysis according to some research 4
When to Seek Further Help
- Reassessment or specialist referral is mandatory if incomplete facial recovery persists at 3 months 1, 3
- Immediate referral needed for new or worsening neurologic findings or ocular symptoms at any point 1, 3
Important Caveats
Taping is only mentioned in Bell's palsy guidelines for eye protection, not for oral symptoms 1. Eye taping or patching must be done with careful instruction on proper technique to avoid corneal abrasion 1. Applying this concept to the cheek has no evidence base and could potentially cause skin irritation or other complications without addressing the underlying muscle weakness.
30% of patients may experience permanent facial weakness with muscle contractures 1, 3. These patients should be referred to a facial nerve specialist for evaluation of reconstructive options, which may include static or dynamic procedures to improve oral function 1.