In cases where the facial nerve is thought to be intact, nonsurgical management is best. These patients should be observed from 6 months to 2 years. Injuries to the temporal and/or zygomatic branches typically are not directly visualized nerve injuries, which make the clinical decision more challenging to manage. If nonsurgical management is chosen, the conservative palliative options include physiotherapy, exercises, and reassurance. Physical therapy is often underutilized in the setting of facial nerve injury . Facial neuromuscular reeducation using surface EMG and biofeedback techniques have demonstrated improvements in facial movement in randomized trials. Botox and corrective makeup techniques have also been used in management of the reanimation of the facial muscles . Types of nonsurgical management are as follows:
The primary goal is to protect the cornea from sight-threatening complications. Correction of eyelid malposition, reduction of epiphora, and improvement of cosmetic concerns are therefore secondary goals. Corneal protection begins with a regimen of regular ocular lubrication and, at minimum, should include application of artificial tears five to ten times per day with ophthalmic ointment at night. Other supplemental measures include the usage of a moisture chamber and taping .