Self-massage and expression muscle rehabilitation for facial palsy
The main cause of facial palsy is facial neuritis, a non-bacterial non-purulent inflammation of the facial nerve, which is a common and multi-infarct disease. It mostly starts due to local wind or cold, so it is usually thought that the local blood vessels that nourish the nerve may spasm due to wind and cold, resulting in ischemia, edema and pressure on the facial nerve tissue and causing the disease.
Treatment of facial palsy includes medication, physical therapy, acupuncture, magnetic therapy and injection therapy around the stem mammary foramen. Mild and moderate cases can mostly recover with active treatment. In severe cases, recovery is mostly incomplete. The main residual symptoms are incomplete or no recovery of the raised eyebrows, incomplete recovery of the perioral muscles including the supraglottis, orbicularis oris and lower lip square muscles and residual symptoms: joint band movement, contracture, ptosis, crocodile tears and facial muscle spasm. This often becomes disfiguring and should therefore be treated aggressively. In addition to selective and comprehensive application of the above treatments according to the patient’s specific situation, if self-massage and expression muscle rehabilitation training can be combined during the acute period, it can promote early recovery of facial palsy.
I. Self-massage
The methods of massage along the muscle direction are introduced as follows.
1. Occipital frontal muscle frontal belly Patients or others can use thumb or finger to gently massage along the frontal belly of occipital frontal muscle from the arch of eyebrow to the top of head and from the top of head to the arch of eyebrow. Massage can gently push and pull from the arch of the eyebrow to the hairline at the top of the head, or slowly rubbing.
2, orbicularis oculi muscle Most of the patients show the dysfunction of eye closure and tearing. The main reason is that the orbicularis oculi muscle cannot contract effectively, pulling down the orbicularis oculi muscle from above the bulging eye to close it. The patient is first asked to close the eyes before using the fingers to massage along the upper and lower eyelids or the depression between the infraorbital rims. Gently pushing and pulling from the inside out and then from the outside in on the upper and lower eyelids will help restore upper eyelid function. This method also helps to close the eyes. In general, peripheral facial palsy mainly manifests as upper eyelid closure disorders. In severe lesioned facial palsy, lower eyelid elevation disorders may be present. Individual patients may have mild lower eyelid ectropion, mainly due to the relaxation of the lower eyelid after facial palsy. This can also be treated with the finger push-pull method described above. The patient is asked to close the eyes and use the thumb and fingertips to gently push and pull along the lower eyelid skin from inward to outward and then from outward to inward, respectively. In individual patients with incomplete upper eyelid closure after most of the facial expression muscles have recovered, massage treatment using this method can avoid or reduce eyelid contracture after recovery.
The upper lip muscle, also known as the upper lip square, originates from the maxillary area above the infraorbital foramen and at the infraorbital rim, where it is located deep within the orbicularis oculi. A part of the muscle fibers of the superior labialis muscle goes down into the skin of the lateral upper lip, and other fibers are interwoven with the orbicularis oris muscle fibers. Therefore, massage should be performed on the affected side of the superior orbicularis oris muscle toward the paranasal and zygomatic areas, and then along the nasolabial folds or up the corners of the mouth toward the zygomatic areas. Use the thumb or show finger and middle finger finger to press the cheek or push and pull along the direction of the muscle massage treatment.
4, zygomatic muscle The zygomatic muscle is divided into zygomatic major and minor muscles, starting from the cheekbone and ending at the corners of the mouth. The main up mentioned to pull the corner of the mouth outward, can be along the muscle fibers, from the corner of the mouth next to the zygomatic bone direction push and pull or press and rub.
5, orbicularis oris muscle Upper orbicularis oris muscle: use the finger of the index finger and thumb, massage along the affected side of the corner of the mouth toward the human middle groove, and then along the human middle groove toward the corner of the mouth. Lower orbicularis oris muscle: use the finger and thumb to massage along the affected side of the corner of the mouth toward the center, and then toward the corner of the mouth on the affected side.
6.Lower lip square muscle: use the thumb to massage and push and pull gently from the lower corner of the mouth to the inner side and downward, which helps to recover the function of lower lip square muscle, chin muscle and deltoid muscle.
Expression muscle rehabilitation training
After the movement of facial expression muscles occurs, effective rehabilitation training of expression muscles can significantly improve the therapeutic effect. The expression muscles mainly involved in facial palsy are frontalis frontalis, orbicularis oculi, upper lip, zygomaticus, orbicularis orbis and lower lip square. The functional training of these major muscles can promote the normalization of the motor function of the entire facial expression muscles. The following treatment methods should be selected according to the patient’s different symptoms during the training, with 2~3 times of training per day and 10~20 times of training for each movement. Specific training methods are as follows.
1, eyebrow raising training The completion of eyebrow raising action mainly relies on the movement of occipital frontal muscle frontal belly. In the disuse type, mild and moderate lesion type facial palsy, the motor function of occipitofrontalis frontalis is the easiest to recover. Patients can be asked to raise the eyebrows on the healthy side and the affected side to help restore the eyebrow raising motor function.
2.Eye Closure Training The function of eye closure mainly relies on the motor contraction of orbicularis oculi muscle to complete. When training eye closure, ask the patient to gently close the eyes at the beginning and close both eyes at the same time for 10~20 times. If the eyelids cannot be completely closed, use the finger belly of the index finger to gently massage along the infraorbital rim when showing white, and then forcefully close the eyes for 10 times to help restore the eyelid closure function.
3. Nose shrugging training The nose shrugging exercise is mainly done by lifting the upper lip muscles and the contraction of the nasal pressure muscles. The nasal shrug training can promote the recovery of the motor function of the nasal pressor and upper lip muscles. A small number of patients do not know how to shrug their noses, so they should pay attention to the direction of the nose when training.
4, show teeth training Show teeth action mainly relies on the contraction of the zygomaticus major and minor muscles, lift the corners of the mouth muscle and smile muscle to complete. The dysfunction of these four muscles is the main reason for the crookedness of the corners of the mouth. The patient is instructed to move the corners of the mouth to both sides at the same time, to avoid only to one side of the force to practice a habitual skewed movement of the corners of the mouth.
5.Nu mouth training Nu mouth mainly relies on the contraction of the orbicularis oris muscle to complete. When performing the nuzzling training, contract the lips and nuzzle forward with force. After the orbicularis oris muscle is restored, the patient can puff up the cheeks, and the symptoms of brushing teeth or eating drooling will disappear. When training the mouth, the motor function of the upper lip, lower lip and chin muscles are trained at the same time.
6, cheek training Cheek training helps to restore the motor function of orbicularis oris muscle and buccal muscle. When the cheek is leaking, use your hand to squeeze the affected orbicularis oris muscle up and down for cheek puffing training. If the patient can perform cheek puffing exercise, it means that the motor function of orbicularis oris muscle and buccal muscle can be restored to normal, and the symptoms of tooth brushing leakage, drooling and food stagnation will disappear. This method helps to prevent and control the contracture of the upper lip square muscle.
The training of each action above is designed for the motor disorders of different muscle groups, so when observing the motor disorders of the patient’s facial expression muscles, the training should be carried out for the involved muscle groups, and if the involved muscle groups cannot be judged effectively, the motor function training can be carried out according to the above procedures, and good rehabilitation results can also be obtained. (Dr. Guo Jinhua, Director of Department of Neurology, Yancheng City Hospital of Traditional Chinese Medicine)