Nature and Timing of Lost Nerve Function Determines Type of Surgery Facial reanimation surgery can take two forms, depending on the nature and timing of the lost nerve function:.
Neuromuscular Retraining (NMR)
One or Two Stages Facial reanimation is performed in one or two stages. When procedures are performed in two stages, they are often separated by a period of 9—12 months. Facial reanimation surgery restores or replaces lost facial movement. A comprehensive consultation will help determine if facial reanimation is right for your condition.
Before your visit, our doctors will want to know:. We also want to review photographs or video demonstrating your ability or inability to perform the following movements:. Facial Reanimation Surgery Isn't for Everyone For example, elderly patients or people with medical conditions that prevent them from undergoing lengthy surgeries may not be candidates for this complex process. It also demands sophisticated operating technology to ensure surgical success. This technical expertise and state-of-the-art equipment are only available at Duke and a small number of other medical centers.
Experienced Specialists Facial reanimation surgery is one component of a comprehensive process that involves a team of experienced specialists. They include:. Contact Us Online.
Call Us Duke MyChart Patient login. Menu Duke logo. Please enable to view treatments. She was instructed to stretch her cheek more often if she experienced cheek muscle tightness throughout the day. Strengthening exercises for specific movements were continued as long as they did not cause synkinesis. The patient's last physical therapy visit was 13 months after the initiation of therapy. The biggest change appeared to be in function. The patient reported no difficulties with eating, drinking, speaking, or protecting the cornea of her eye.
She had even resumed swimming. Patient satisfaction was high by patient report. Based on these signs and symptoms, we still considered the patient to be in the movement control treatment category, with relaxation the secondary treatment category. Because minimal changes were noticed in voluntary movement in the previous 7 months, strengthening was no longer, in our opinion, a reasonable goal. We instructed the patient in a final program to help maintain her facial function and to prevent any inappropriate muscle activity or synkinesis.
The program consisted of isolated facial movements, stretching, facial massage, and relaxation exercises 19 typical for patients in the movement control and relaxation treatment categories. Jacobsen's relaxation exercises 19 and the same technique of progressively contracting and relaxing of muscles was applied to specific facial muscles. MC was instructed to continue with this program one time a day, gradually weaning herself from the exercise program.
Modern concepts in facial nerve reconstruction | Head & Face Medicine | Full Text
She was told to continue with the facial muscle stretches at least one time a day or more as she felt she needed it to prevent further facial muscle tightness. The patient was treated over a month period and seen for only 14 physical therapy sessions. Initially, the treatment sessions were more frequent 2—4 times per month because of the need for instruction and for the patient to become familiar with the exercise process. As the patient became more aware of her facial movements, she was treated less frequently once every 3 months.
Table 2 shows the physical therapy schedule. The patient demonstrated improvements as facial impairments and functional limitations became less severe Tab. In our opinion, moderate improvements were made in symmetry of the face at rest, even though these improvements were not evident in the FGS rest scores. The FGS grades resting posture as being either symmetrical or asymmetrical and does not account for levels of severity.
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The most noticeable changes were the improvement of her voluntary movement FGS movement , which occurred in the first 7 months of treatment, and the development of synkinesis FGS synkinesis in the seventh month. The patient's functional activities improved so that after 13 months she had no difficulty eating, drinking, speaking, or protecting the cornea of her eye. She no longer had to rely on compensatory techniques to complete her activities of daily living.
She had even returned to swimming between the 7th and 13th months of treatment. The patient was highly satisfied with her outcome. In our experience, individuals with Bell palsy are seldom referred for physical therapy at the onset of the disorder. Often, they are told to wait and that this condition will get better on its own. Complete recovery does not always occur, especially in high-risk populations such as people who are elderly or who have delayed recovery.
Physical therapists rarely continue to treat patients for 13 months. We believed, however, that this treatment duration was necessary to achieve the outcomes for this patient. For the first 7 months, the patient had facial weakness and was treated with strengthening exercises. At the 7-month visit, she had facial muscle overactivity and synkinesis. At this point, the treatment plan was adjusted to fit the changes in her facial impairments. If the physical therapy had been terminated prior to this 7-month mark, her problems of facial muscle tightness and synkinesis would not have been addressed.
Instructing the patient in a maintenance program at the last physical therapy session may help to prevent an increase in facial muscle tightness and synkinesis over time. Although 13 months may seem like a long time to treat a patient, the total number of physical therapy visits was only 14 visits. Physical therapy for patients with facial paralysis traditionally has consisted of generic facial exercises or electrical stimulation. In our approach, the exercise program changes over time as the patient's impairments change with recovery.
The facial neuromuscular re-education exercise program emphasizes accuracy of facial movement patterns and isolated muscle control, and it excludes exercises that promote mass contraction of muscles related to more than one facial expression.
Facial rehabilitation treatments
In our approach, the number of exercise repetitions and the frequency of the exercise program depend on the treatment-based categories, which are based on the patient's impairments Tab. Continued research is needed to determine the best treatment for individuals with facial neuromuscular disorders.
A first step could be to validate the treatment-based classification system based on the physical signs and symptoms of individuals with facial neuromuscular disorders. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Oxford Academic. Google Scholar. Jessie M VanSwearingen. Cite Citation. Permissions Icon Permissions. Abstract Background and Purpose. Bell palsy , Classification system , Facial neuromuscular re-education , Facial paralysis. Table 1. Open in new tab. Table 2.
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Suppression of neurite elongation and growth cone motility by electrical activity. Search ADS. Effect of electrotherapy on denervated muscles in rabbits: an electrophysiological and morphological study. Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal-facial nerve anastomosis.
Validation of a treatment-based classification system for individuals with facial neuromotor disorders. Trigeminal-facial nerve communications: their function in facial muscle innervation and reinnervation.
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