Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal‐facial nerve anastomosis

Abstract

For reinnervation of facial paralysis, the XII-VII nerve anastomosis provides tone and mass contraction but rarely allows selective muscle control. The efficacy of EMG rehabilitation was evaluated in 30 patients who had no coordinated control of facial muscles. EMG signals from bilateral homologous facial muscle sites were converted into computer-compatible waveform traces and displayed on a video monitor. This facilitated modification of neuromuscular responses using behavioral shaping techniques. A six-point Facial Nerve Grading Scale was introduced for hypoglossal-facial nerve anastomosis to assess the results of EMG rehabilitation. Rehabilitation lasted from 3 to 18 months. Ten patients (33%) achieved the highest possible grading (II) with symmetry and synchrony of function and spontaneity of expression; 17 (57%) reached grade III, which allowed voluntary control of eye and mouth function; 3 (10%) showed minimal gains. It is suggested that neural plasticity allows therapeutic manipulation of central facilitory and inhibitory mechanisms, and possible unmasking of neural connections between the ipsilateral VII and XII nerve motor nuclei which leads to improved facial function.

Measuring Quality of Life and Patient Satisfaction in Facial Paralysis Patients

“…18 Questions were also selected and adapted from the disability component of other instruments. 7,8 The initial form of the Facial Disability Index was refined slightly after the first 6 months of use, based on commonly noted physical disabilities that patients described to the physical therapists at the Facial Nerve Centre. 18 Formal item-reduction methods were not described.…”

“…Social functioning was adequately covered by both the Facial Disability Index and the Facial Clinimetric Evaluation Scale. 8 The questionnaire by Borodic et al includes items related to peripheral visual function, a subjective morbidity experienced by patients with synkinetic eyelid closure from chronic aberrant facial nerve regeneration. As such, this instrument may not be applicable to the general facial paralysis population.…”

Electron Microscopical Evidence of Synaptic Reorganization in the Contralateral Motor Cortex of Adult Rats following Facial Nerve Lesion

“…From the clinical point of view it is not only of interest whether synaptic reorganization induces transient or per manent functional changes to explain the above-men tioned clinical phenomena [1][2][3], It should also be an aspect of further investigations whether these changes may be influenced by certain training methods or phar macological therapy e.g. by corticosteroids.…”

“…Shimono et al [1] demonstrated an improvement in synkinesis in patients who underwent electromyographic (EMG) feed back training. Brudny et al [2] observed better results of mimic expression after hypoglossal-facial nerve anasto mosis using EMG feedback training during the reinnerva tion period. Laskawi et al [3] found synkinesis in patients that showed no degeneration potentials in the EMG dur ing Bell's palsy.…”

Facial nerve reconstruction in salivary gland pathology: A review

“…Bilateral homologous facial muscle electromyography with computer integrated video monitoring and feedback for 3-18 months enables up to 30% of patients to achieve synchronous symmetrical motion and spontaneous expression while 60% obtain independent voluntary oral and orbital function with less synkinesis noted. 43 Severe atrophy and paralysis of the tongue occur in 25% of patients with 50% and 25% reporting mild and minimal changes, respectively. Up to three quarters of patients complain of some difficulty mobilizing food but few report swallowing dysfunction.2 Up to one-half report "thickness" of speech, usually well tolerated.37 In one series, 20% reported ophthalmologic problems (dryness, irritation, pain, and altered vision).…”