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.