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Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal‐facial nerve anastomosis
Author(s) -
Brudny Joseph,
Hammerschlag Paul E.,
Cohen Noel L.,
Ransohoff Joseph
Publication year - 1988
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-198804000-00010
Subject(s) - reinnervation , facial nerve , facial paralysis , medicine , facial muscles , rehabilitation , synkinesis , paralysis , anatomy , anastomosis , electromyography , physical medicine and rehabilitation , palsy , surgery , physical therapy , pathology , alternative medicine
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 (IT) 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.