Muscle activity in the partially paralyzed face after placement of a fascial sling : A preliminary report

Neuromuscular re-education (ie, physical therapy) is often the first treatment given to patients with a partial facial paralysis. The purpose of this paper was to examine whether by repositioning and supporting partially paretic muscles with a fascial sling, one could improve facial movement in patients for whom the benefits of physical therapy had plateaued. Six patients with a history of unilateral, partial facial paralysis were assessed using the Facial Grading System (FGS) and surface electromyography (EMG) recordings of facial muscle activity. Automated facial analysis (AFA) was used to measure the facial excursions of the most recent patient. The FGS composite scores indicated improvement following static sling placement in all patients. The FGS subscale scores for voluntary movement indicated that the excursion of facial movement increased in 4 of the 6 patients. Surface EMG data demonstrated increased muscle activity in the zygomaticus major muscle in all patients. AFA demonstrated that following sling placement, the excursion of the lip commissure nearly doubled. The sling procedure, traditionally considered an intervention for improving static symmetry of the face, may also be useful for enhancing movement in some patients with a partial facial paralysis. Additional data, such as measurements provided by AFA, are needed to correlate facial displacement with EMG muscle activity.