Abstract
Background and Clinical Significance: Chronic peripheral facial paralysis can remain disabling beyond the period in which spontaneous recovery is most likely and may involve persistent neuromuscular, connective-tissue, psychosocial, and neuroplastic consequences. Photobiomodulation (PBM) has been investigated as an adjunct to facial rehabilitation because of its potential effects on mitochondrial and redox signaling, microvascular support, inflammatory regulation, and neural repair. Case Presentation: A 60-year-old woman with approximately 12 months of chronic left-sided peripheral facial paralysis presented with marked facial asymmetry, impaired dynamic expression, and House-Brackmann (HB) grade V facial nerve dysfunction. She underwent a 20-session M.A.C.-guided regenerative physiotherapy program integrating facial neuromuscular retraining with PBM. Results: Serial clinical assessment documented progressive restoration of facial symmetry, voluntary muscle recruitment, eye closure, oral competence, and expressive control, with a final HB grade I. No clinically relevant adverse events were reported during the treatment course. Conclusions: The HB V-to-I trajectory after 20 sessions in a chronic case is clinically noteworthy but cannot establish treatment-specific efficacy or causality. The case is interpreted through a hypothesis-generating Regenerative Synchronization Theory (RST) and Computational Regenerative Physiotherapy Framework (CRPF), in which recovery is conceptualized as an emergent interaction among bioenergetic, vascular, inflammatory, extracellular-matrix, and neuroplastic domains. These theoretical constructs are not validated predictive models. Prospective controlled studies with standardized PBM dosimetry, electrophysiology, validated facial metrics, imaging, biomarkers, and long-term follow-up are warranted.