The recovery of the spontaneous smile after facial reanimation

Background: The social smile is quite distinct from the genuine smile. The two types smile are controlled by entirely separated brain circuits: the spontaneous smile emerges from the unconscious limbic system, while the social smile comes from the conscious motor cortex. Moreover, the two types of smile are brought about by a different set of facial muscles, because some facial muscles are outside cortical control The mixed facial reanimation technique after a facial paresis goes good symmetry ot the face at rest, while smiling movement is achievable, but not guaranteed. During rehabilitation treatment alter facial reanimation, patients are commonly trained to “feel” the movement, to perform symmetrical movement with the contralateral side of the face and to reduce synkinesias as much as possible. This study sets out to determine whether, after facial reanimation, a comprehensive rehabilitation, including emotional training, may influence the functional outcome of patients. Patients and methods: This is a quasi-experimental study (before and after). Six patients (19-66 years; 2 females), after facial reanimation for facial paresis, underwent to comprehensive rehabilitation including emotional training sessions once a week tor 6 months. Emotional training was obtained by asking patients to recall different emotions, Each patient was evaluated at the beginning, in the middle and at the end of the rehabilitation program. The House-Brackmann scale (HSB) was used to evaluate global degree ot facial palsy and provides a score from 1 (normal) to 6 (paralysis). The Sunnybrook Facial Grading System (SFGS) was used to combine a static and a dynamic assessment of facial muscles with the degree ot the severity ot facial Palsy and provide a clinical score from 0 (paralysis) to 100 (normal). Results; After the rehabilitation program a global improvement o to paresis was observed (HSB, Friedman test, p=0.00054). A better simmetry of face at rest (SFGS, Friedman test, p=0.0162) and during voluntary movement (SFGS, Friedman test, p=0.0002) was observe. Discussion and conclusions: The neural network that mediates the emotional training effects could include structures of the limbic system which are known to project to the motor neurons of the facial muscles, via the midcingulate area. At the end ot the rehabilitation program the patients had a quite good symmetry ot the face at rest and were able to smile automatically in appropriate situations. Emotional training is a promising tool for the recovery of spontaneous emotional, especially for automatic smile.