Rehabilitation Strategies for Facial Nerve Injuries

Many treatment techniques, including exercise, electrical stimulation, biofeedback, and neuromuscular retraining, have been described for the treatment of patients with facial paresis. The degree of nerve injury determines the recovery of the facial muscles. Patients with a Sunderland third-degree injury benefit most from therapy to maximize facial nerve function. Following a facial nerve palsy, many patients present with facial muscle weakness in addition to aberrant synkinetic movements. Therefore therapy must be directed toward control of voluntary movement and decreasing synkinesis. Neuromuscular reeducation involves selective muscle control to decrease synkinesis and increase muscle excursion. Muscle reeducation using surface electromyographic (EMG) biofeedback and home exercises has been shown to be efficacious in the treatment of facial palsies. Neuromuscular retraining can be beneficial in maximizing facial recovery by initially decreasing aberrant synkinetic muscle activity and then increasing voluntary movement and excursion.

KEYWORDS

Facial nerve injury - rehabilitation - neuromuscular reeducation

REFERENCES

• 1 Brach J S, Van Swearingen J M, Delitto A, Johnson P C. Impairment and disability in patients with facial neuromuscular dysfunction.  Otolaryngol Head Neck Surg. 1997;  117 315-321
• 2 Jugenburg M, Hubley P, Yandell H, Manktelow R T, Zuker R M. Self-esteem in children with facial paralysis: a review of measures.  Can J Plast Surg. 2001;  9 143-146
• 3 Bach-y-Rita P. Brain plasticity as a basis for recovery of function in humans.  Neuropsychologia. 1990;  28 547-554
• 4 Malessy M J, Thomeer R T, van Dijk J G. Changing central nervous system control following intercostal nerve transfer.  J Neurosurg. 1998;  89 568-574
• 5 Malessy M J, van der Kamp W, Thomeer R T, van Dijk J G. Cortical excitability of the biceps muscle after intercostal-to-musculocutaneous nerve transfer.  Neurosurgery. 1998;  42 787-794
• 6 Merzenich M M, Jenkins W M. Reorganization of cortical representations of the hand following alterations of skin inputs induced by nerve injury, skin island transfers and experience.  J Hand Ther. 1993;  6 89-104
• 7 Balliet R. Facial paralysis and other neuromuscular dysfunctions of the peripheral nervous system. In: Payton OD Manual of Physical Therapy. New York; Churchill Livingstone 1989: 175-213
• 8 Balliet R, Shinn J B, Bach-y-Rita P. Facial paralysis rehabilitation: retraining selective muscle control.  Int Rehabil Med. 1982;  4 67-74
• 9 Brach J S, Van Swearingen J M, Lennert J, Johnson P C. Facial neuromuscular retraining for oral synkinesis.  Plast Reconstr Surg. 1997;  99 1922-1931
• 10 Brach J S, Van Swearingen J M. Physical therapy for facial paralysis: a tailored treatment approach.  Phys Ther. 1999;  79 397-404
• 11 Brown D M, Nahai F, Wolf S, Basmajian J V. Electromyographic biofeedback in the reeducation of facial palsy.  Am J Phys Med. 1978;  57 183-190
• 12 Brudny J. Biofeedback in facial paralysis: electromyographic rehabilitation. In: Rubin L The Paralyzed Face. St. Louis; Mosby 1991: 247-264
• 13 Brudny J, Hammerschlag P E, Cohen N L, Ransohoff J. Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal-facial nerve anastomosis.  Laryngoscope. 1988;  98 405-410
• 14 Cronin G W, Steenerson R L. The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation.  Otolaryngol Head Neck Surg. 2003;  128 534-538
• 15 Nakamura K, Toda N, Sakamaki K, Kashima K, Takeda N. Biofeedback rehabilitation for prevention of synkinesis after facial palsy.  Otolaryngol Head Neck Surg. 2003;  128 539-543
• 16 Ross B, Nedzelski J M, McLean J A. Efficacy of feedback training in long-standing facial nerve paresis.  Laryngoscope. 1991;  101 744-750
• 17 Segal B, Zompa I, Danys I et al.. Symmetry and synkinesis during rehabilitation of unilateral facial paralysis.  J Otolaryngol. 1995;  24 143-148
• 18 VanSwearingen J M, Brach J S. Changes in facial movement and synkinesis with facial neuromuscular reeducation.  Plast Reconstr Surg. 2003;  111 2370-2375
• 19 Adour K K, Swanson Jr P J. Facial paralysis in 403 consecutive patients: emphasis on treatment response in patients with Bell's palsy.  Trans Am Acad Ophthalmol. 1971;  75 1284-1301
• 20 Burres S A, Fisch U. The comparison of facial grading systems.  Arch Otolaryngol Head Neck Surg. 1986;  112 755-758
• 21 House J W. Facial nerve grading systems.  Laryngoscope. 1983;  93 1056-1069
• 22 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
• 23 May M. Facial paralysis, peripheral type: a proposed method of reporting (emphasis on diagnosis and prognosis, as well as electrical and chorda tympani nerve testing).  Laryngoscope. 1970;  80 331-390
• 24 Ross B G, Fradet G, Nedzelski J M. Development of a sensitive clinical facial grading system.  Otolaryngol Head Neck Surg. 1996;  114 380-386
• 25 Neely J G, Cheung J Y, Wood M, Byers J, Rogerson A. Computerised quantitative dynamic analysis of facial motion in the paralysed and synkinetic face.  Am J Otol. 1992;  13 97-107
• 26 Neely J G, Joaquin A H, Kohn L A, Cheung J Y. Quantitative assessment of the variation within grades of facial paralysis.  Laryngoscope. 1996;  106 438-442
• 27 Brackmann D E, Barrs D M. Assessing recovery of facial function following acoustic neuroma surgery.  Otolaryngol Head Neck Surg. 1984;  92 88-93
• 28 Chee G H, Nedzelski J M. Facial nerve grading systems.  Facial Plast Surg. 2000;  16 315-324
• 29 Kayhan F T, Zurakowski D, Rauch S D. Toronto facial grading system: interobserver reliability.  Otolaryngol Head Neck Surg. 2000;  122 212-215
• 30 Farragher D, Kidd G L, Tallis R. Eutrophic electrical stimulation for Bell's palsy.  Clin Rehabil. 1987;  1 265-271
• 31 Sunderland S. Nerve and Nerve Injuries. Edinburgh; Churchill Livingstone 1978
• 32 Axelsson S, Lindberg S, Stjernquist-Desatnik A. Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy.  Ann Otol Rhinol Laryngol. 2003;  112 197-201
• 33 Hato N, Matsumoto S, Kisaki H et al.. Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisone.  Otol Neurotol. 2003;  24 948-951