Physical therapy

Methods of rehabilitation for facial paralysis have included massage, electrical stimulation, and repetition of common facial expressions. The most promising treatment technique is facial neuromuscular reeducation using surface electromyography (sEMG) or mirror biofeedback. This is a process of relearning facial movement using specific and accurate feedback to enhance facial muscle activity while suppressing abnormal movement. The program is highly individualized and requires multiple visits to a physical therapist for treatment. Any of these techniques should be considered early in the evaluation of facial nerve injury and implemented immediately for positive results [15, 23, 24].

Botulinum toxin

Botox is a relatively new treatment in the nonsurgical armamentarium for management of facial nerve injuries. In the context of facial neuromuscular disorders, Botox was initially used to treat patients with symptoms due to Bell’s palsy. When the facial nerve is injured in the approach to the temporomandibular joint, possible aberrant regeneration of fibers may lead to unwanted affects such as involuntary spasms of the orbicularis oculi and lacrimation of the affected eye (synkinesis). Botox works by blocking the presynaptic release of acetylcholine, which causes functional denervation of neuromuscular endplates. Because fibers to the lacrimal gland utilize acetylcholine as a neurotransmitter, local injections of Botox into the gland can remedy lacrimation. Injection into the orbicularis oculi muscle can control facial synkinesis.

Botox may also be applied to the non-operated (contralateral) frontalis muscle to mask the operated (ipsilateral) frontalis weakness [15, 25, 26].

Corrective makeup techniques

Outside of the typical use of covering one’s face for color, makeup can be used as a cognitive interactive technique that can change a person’s appearance and create different impressions using optical illusions. Kanzaki et al. reported the use of makeup techniques to improve the appearance in two women with House- Brackmann grade III. An expert beautician instructed the women on the application of makeup to correct facial imbalance. In both cases, it was determined that the makeup lead to positive changes, including reduction in depression and feelings of inferiority. This is a low-cost and low-risk nonsurgical technique to improve facial reanimation features following nerve injury [27].

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