Facial Nerve Rehabilitation
What is Facial Palsy Therapy (Neuromuscular Retraining)?
Facial palsy therapy is a crucial component of the rehabilitation process for individuals affected by facial palsy. Skilled therapists play a vital role in guiding patients through this specialized therapy. An individualized therapy plan is created after a thorough assessment of facial function. Therapy involves a series of targeted exercises, stretches, and techniques aimed at re-training the affected facial muscles. Through a combination of manual techniques — including massage, stretching, and mirror feedback — therapy aims to regain control and coordination of facial movements. The goal of facial therapy is to restore muscle functionality, enhance facial movement and symmetry, and improve quality of life.
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Medicinal BOTOX® for Facial Palsy
Medicinal botulinum toxin, or BOTOX®, is among the injectables frequently utilized for treatment in patients with facial palsy, synkinesis, or chronic hemifacial spasm. BOTOX® is administered through a series of injections into carefully selected facial muscles. The goal of this non-invasive treatment is to relax the asymmetric and hyperactive muscles to provide a more harmonious facial functionality. This clinic injection is well-tolerated and does not require downtime. BOTOX® takes about one week to take effect. Once active, it leads to gradual improvement in facial function. This treatment may be covered by your insurance. The effects of BOTOX® are temporary and require repeat injections approximately every 3 months for sustained benefit.
Depressor Anguli Oris (DAO) Resection
DAO resection is a surgical procedure performed to address the effects of facial palsy and, particularly, those who have developed synkinesis. This procedure specifically targets the depressor anguli oris muscle, which is responsible for pulling down the corner of the mouth. When affected by facial palsy (most commonly after Bell’s Palsy, Ramsey Hunt Syndrome, or Acoustic Neuroma), this muscle can become hyperactive and cause a tightening and pulling on the affected side of the face. The goal of the procedure is to provide a more balanced and aesthetically pleasing smile.
During DAO resection surgery, a small incision on the inside of the mouth is performed. The muscle is identified and removed, thereby reducing the downward pulling effect on the corner of the mouth while smiling. No incisions on the outside of the face are required.
Selective Neurectomy
Selective neurectomy (also referred to as selective neurolysis) is a surgical procedure aimed at improving facial function in individuals with facial palsy and synkinesis. This procedure is typically considered when conservative treatments like facial therapy and medicinal botulinum toxin have not optimized facial function restoration. The goal of this surgery to enhance smile symmetry and reduce facial tightness and hyperactivity. This is often performed through a facelift incision.
Nerve Transfer Procedures
Nerve transfer procedures are surgical techniques performed by facial plastic surgeons to restore function and movement to those with facial paralysis. These procedures involve rerouting healthy nerves from other parts of the head and neck to the facial nerve. This allows for restoration of movement to the facial muscles. Two common nerve transfer procedures for facial palsy include the “nerve to masseter transfer” and the “hypoglossal nerve transfer.”
Nerve to Masseter Transfer to Facial Nerve (5-7)
This procedure utilizes the motor branch of the trigeminal nerve, which controls the masseter muscle (responsible for chewing). The nerve is rerouted and microscopically stitched to the facial nerve. This technique can restore strong smile movement to the face when biting. You may see this abbreviated as the “5 to 7 procedure” as the trigeminal nerve is the fifth cranial nerve and the facial nerve is the 7th cranial nerve.
Hypoglossal Nerve Transfer to Facial Nerve (12-7)
With this approach, your surgeon utilizes a portion of the hypoglossal nerve, which controls movements of the tongue. The facial nerve is rerouted down to the location of the hypoglossal nerve underneath the chin. This procedure aims to restore resting symmetry (resting tone) of the face. You may see this abbreviated as “12 to 7 procedure,” as the hypoglossal nerve is the twelfth cranial nerve and the facial nerve is the 7th cranial nerve.
Facial Static Suspension
Facial static suspension is a surgical procedure aimed at restoring facial symmetry for those who have experienced facial paralysis. There are certain instances in which suspension procedures are more advantageous than other dynamic restoration techniques. Suspension procedures are optimal for individuals who lack candidacy for other facial reanimation techniques. Static suspension aims to improve facial symmetry, but can also lead to improved speech articulation, communication, and eating and drinking, as well as drooling. When completed with nasal valve static suspension, this procedure also improves breathing through the nose.
Cross Face Nerve Grafting
Cross face nerve grafting is a surgical procedure used to restore spontaneous facial function in individuals suffering from facial palsy or facial paralysis. During a cross face nerve grafting procedure, the functioning facial nerve (from the unaffected side of the face) is connected to the non-functioning facial nerve through a long nerve graft. This nerve graft serves as an “extension cord” for nerve signals to travel from the healthy facial nerve to the impaired facial nerve. This can restore spontaneous facial muscle movement and facial expression. Most often, this procedure is performed as a first-stage surgery prior to gracilis free muscle transfer surgery. The nerve graft is then used to provide nerve supply to the transplanted gracilis muscle during the second stage surgery.
Gracilis Free Muscle Transfer
Facial paralysis can result from a variety of causes, and undoubtedly has a significant impact on a person’s quality of life. It affects their ability to express emotions, smile, interact and communicate with others. It is not uncommon for patients with facial paralysis to even feel a loss of their own personal identity. The gracilis free muscle transfer is a surgical procedure employed in facial reanimation surgery to restore movement and function to a face that has experienced long-standing paralysis (typically multiple years of paralysis).
The gracilis free muscle transfer is a surgical procedure that involves the transplantation of the gracilis muscle, which is a long, slender muscle located in the leg to the face to “reanimate” the smile. The goal of this procedure is to restore movement to the face and provide the ability to smile.
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