Comprehensive rehabilitation training after iatrogenic facial nerve palsy

Introduction. Iatrogenic facial nerve injury may occur after surgical procedures and leads to facial disfigurement and functional limitations. After a facial nerve injury, clinical prediction rules define three phases: complete denervation, first manifestation of reinnervation and functional recovery. Patients with facial nerve palsy experience physical, psychological and social disabilities. Many studies support significant benefit from rehabilitation for the idiopathic facial paralysis; contrariwise the efficacy of rehabilitation is uncertain for iatrogenic facial palsy. Aim. This study sets out to determine whether a comprehensive rehabilitation training, adapted to the stages of recovery after facial iatrogenic nerve injurie, influences the functional outcome of patients. This training has the aim to facilitate the return of intended facial movement patterns and to eliminate unwanted patterns of facial movement (synkinesias). Materials and method. The Sunnybrook Facial Grading System (SFGS)1 was used to assess the severity of facial palsy. This scale provides a clinical score from 0 to 100 which combines a static and dynamic assessment of facial muscles with the degree of synkinesias. The Facial Disability Index (FDI)2 is a disease-specific, self-report instrument for the assessment of disabilities of patients with facial nerve disorders. It’s divided in two subscales: the physical function and the social/well-being function. Each subscale provides a score from 0 to 100. Ten patients (19-67 years; 4 females) suffering an iatrogenic nerve palsy (i.e. after parotidectomy, acoustic neuroma surgery, vascular surgery) occurred 18-24 months before, underwent 20 physiotherapy sessions. Each session (45 minutes long), was led by a physiotherapist. Each patient was evaluated at the beginning, in the middle and at the end of the rehabilitation program. Results After the rehabilitation program most symmetry of face at rest (SFGS, Friedman test, p=0.0003) and during voluntary movements (SFGS, Friedman test, p=0.0001) was observed. Presence and severity of synkinesias did not improve significantly (SFGS, Friedman test, p=0.5585). After rehabilitation program patients feel an improvement of social/well-being function (FDI, Wilcoxon test, p=0.0006) but not an improvement of physical function (FDI, Wilcoxon test, p=0.058). Discussion. Comprehensive rehabilitation training seems beneficial for people following iatrogenic facial nerve injury. People regain facial symmetry at rest and during voluntary movement and feel a reduced degree of subjective distress. The synkinesias do not improve significantly, but the positive trend indicates that the training may have a prevention role in the developing of such phenomena. Conclusion. Comprehensive training is a promising tool for the recovery of an iatrogenic facial nerve lesion. Bibliography 1 - Pavese C, Tinelli C, Furini F, Abbamonte M, Giromini E, Sala V, et al. Validation of the Italian version of the Sunnybrook Facial Grading System. Neurological Sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2013;34(4):457-63. 2 - VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Physical therapy. 1996;76(12):1288-98.