Should I start facial exercise after surgery

[Headtheball14]

Hi,
I just had surgery on18/06 . Everything looked ok out of surgery then I had slight weakness afterwards, grade 3
The last few days my face has dropped. I have no tears that side, mouth is drooping. Difficulty speaking clearly and eating normally .
My physio said not to start exercises yet and to wait six months or so.
I guess I feel I should be doing something.
What is the standard recommendation?
Any advice?
Thanks

[Jill Marie]

If memory serves me correctly most people on this board have said they were told to wait at least 6 months before starting the exercises.  You can do a search as there have been many posts about this.  Hopefully others will chime in as well. 

Make sure you are taking really good care of your eye, there are tons of threads about that as well.  Feel free to ask questions too, sometimes that's quicker than trying to go through all the threads.  Take Care and keep posting, we like to help when we can.  Jill

[Headtheball14]

Thanks for that Jill Marie.
It looks like all of the advice is not to proceed with exercising. I found some research papers that suggested it could make a difference but I'll go with the status quo. I will check out the eye threads for the moment. Just over two weeks since surgery and it feels very up and down. Thanks

[alabamajane]

Hi,
I am almost 4 yrs out from surgery and I would agree that 6 mos is about the timeframe to see movements begin. That's when I saw slight signs. Although, I had my facial nerve severed and a nerve graft done so I may be in slightly different category than you if your nerve is intact. But I would still consider 6 mo as guideline.

I did start VERY light facial massage myself perhaps sooner to help nerve "connect" and muscle "remember " what is was supposed to do. But,,, that wasn't by Drs orders and I'm only telling you what I did,, not suggesting it for you. You don't want to over stimulate it so as not to cause undo synkenisis.

Good luck and just do what you are comfortable with. Let us know how it goes for you!!
Jane

[xiphias]

Hi there,

I have a completely different experience, but seem to be well in the minority. I had almost complete facial paralysis on one side following surgery, but the nerve was not cut and was expected to recover. My neurologist advised me to massage my face regularly in the first few weeks, and my physio started me on some mild electrical stimulation and facial exercises within a week of surgery. Now I'm 5 months post-surgery and my face is about 80% recovered; my eye doesn't entirely close if I'm not paying attention, and my smile pulls a little to the side, but I can pull off a regular conversation and I'm still seeing ongoing improvement. Your mileage may vary (and obviously many other people's does).

[marcdi]

I'm currently just over 4 months post op and was referred to a physiotherapist about a month after surgery to begin electro stimulation. For the first 3.5 months post surgery, I had very little, possibly no noticeable improvement (although friends and colleagues believe they saw a "tightening" around my mouth and I looked less sad!). In the past 2 to 3 weeks I'm starting to actually see noticeable, measurable and actual movement around my forehead and nose. My speech has also improved dramatically. This was a huge milestone for me and fellow AN candidates as up until this point, you suspect any movement may have been a figment of your imagination!

I guess everyone will have a different take and experience on this, but I, like you, wanted to feel in control of my recovery and my regular visits to the physiotherapist have helped with this. I've got a long way still to go in terms of facial recovery but I'm hoping things will begin to accelerate now that I'm over the 4 month mark.

I also think we need to distinguish between facial exercises and electro stimulation. I'm of the impression that I need to have stimulating muscles and once they're stimulating, then I can start thinking about exercising them in order to regain loss of muscle tone and the overcompensation from the other side of my face. This is my opinion though so feel free to interrogate it.

A little about me: I'm a 29 year old guy and I had a 3cm x 3cm Acoustic Neuroma which was removed on 19 Feb 2015. I was very fortunate that my facial nerve remained in tact and stimulated well post the surgery, but alas, the nerve still got quite bruised and stretched so needs some time to compose itself again. I also was one of the lucky guys needing to have another surgery to fix a CSF leak (surgery on 10 March 2015).

A chronology of what I've experienced is as follows:
- Immediately post surgery for about a month I really battled to swallow.
- My eye regained its ability to create tears about 2.5 - 3 months into my recovery and I've used a great deal less eye drops since then. It was around this time that my taste started improving. Up until this point, everything tasted quite metallic and chemically.
-Resumed exercise again around 3 months post surgery (albeit light exercise at the gym)
- First noticeable improvement in terms of facial movement was just after 4 months.

Like I said, I've still got a way to go before my face is ok again but I needed to feel in control of the process. Other things I did (based on research with mixed conclusions and opinions) was to take vitamin B12 as well as Omega 3 supplements as there's a linkage between these vitamins and nerve regeneration. My logic is that they're good supplements so what harm could it cause in light of mixed conclusions?

Finally, take daily/weekly photos and videos of your face to track improvement. Videos help with being able to notice subtle movements which can't be determined with photos. This nerve recovers painfully slowly and it's all about the subtle changes!

I hope this helps a bit!

[Sonia in Sydney]

Hi,

I am just over 5 months post op and have been advised by a very well known physiotherapist/lecturer here in Sydney, Australia that facial exercises are pointless until there are some signs of facial movement. Like marcdi, i could not just wait doing nothing so i have been having acupuncture and recently commenced cranial osteopathy. I have a few different exercises i practice everyday in front of the mirror which the physio gave me in hospital. I don't think they are too intense so i cant see why they would cause me any harm. I have read many posts on this forum and our Australian web site. There are so many different opinions to consider and of course your doctors advice is very important but at the end of the day, its your body, your recovery and you need to decide what you feel comfortable with to help you return to your old self.

Ps. marcidi - great post. I found it really useful and a positive recovery journey to read especially as i am just a month ahead of you with my recovery. Can you tell me more about electro stimulation and how it works and if you believe this has been the reason for your signs of movement/change? I also like the idea of taking some supplements to help nerve regeneration. Was this on advice from a doctor or this web site?

[marcdi]

Hi Sonia in Sydney

Reading your story and details about your op, it looks like you and I have travelled the journey virtually parallel to one another! CSF leaks, right side paralysis, total right side deafness, balance improvement etc!

You're right - there's a myriad different streams of advice out there and everyone has great advice from the best surgeons and healthcare professionals out there. It's for the reason I don't really think anyone is wrong or right. The nerve grows terribly slowly, but we as humans are generally impatient and want instant gratification and results so we will try anything to attain that! What makes it even more difficult to decide upon the whole facial stimulation and exercise versus leave it and give it time decision is that you don't really know if the treatment is actually helping or that any improvement is merely a result of the passage of time. It's a difficult one!

My sister is a Physiotherapist and the benefit of this is she has access to a large network of specialists, one of these being a lady (apparently top in her field) who is a physiotherapist but specialises only in nerve damage/ repair and pain management. She firmly believes in the electro stimulation route and encouraged me to consult with her.

I don't know if it was the passage of time or her treatment, but immediately after our first session, I could wrinkle the spot between my eyebrows. In terms of the treatment itself, there are 2 legs to it:

The first leg is electro stimulation using this device (I think it's called an NMS?) which emits an electric charge through this pen-shaped tool. This tool is pushed against the 5 different branches of your facial nerve for a period of time. I find that the different branches of my nerve are in various stages of responsiveness.

The second leg is electro acupuncture where she insert acupuncture needles into key areas and then connects the needles to an electrical unit. Once again a charge is emitted but this charge goes a little deeper for a longer period. It sounds like i'm being connected to a car battery but it's really rather painless!

I feel this is working for me but no doubt there is a variety of opinions out there. What I can tell you is that my surgeon (also a leading guy with acoustic neuromas) and my old physio as well as my sister (the physio specialising in neural damage) have all encouraged me to explore this avenue. To date, and touch wood, I have no regrets. But this is my experience and I really want everyone reading to come to their own independent conclusions.

Regarding the supplements, this decision was much less scientific: I just Googled "Supplements that aid nerve repair" and that is what popped up. You can't go wrong though - they're good for you regardless of nerve damage!

I've still got a huge way to go in terms of getting my face back to normal. You and I are still at the early stages! How's your recovery going? Any twitches yet?

[Sonia in Sydney]

Thanks marcdi. I very much appreciate the really thorough explanation. I have been really open minded on my road to recovery and exploring all avenues i hear about before i decide on the treatments that suit me best. 

I have had a few little tingles but not much recently. I have also had watering from my eye a few times, twice this weekend. My most exciting news is that i had my EMG test on Friday and it found some reaction near my affected eye and plenty of reaction around my mouth. Nothing above my eyebrow. I haven't seen my neurosurgeon yet to explain the results properly but i do recall him saying in previous appointments that any nerve activity was a positive sign of the nerves regenerating so hopeful i wont have to go down the path of more surgery.

Like you say, its hard to know whether treatment or the passage of time has aided these results but i am keeping at it all for now as i think at the very least it helps me positively focus on my recovery. (in between looking after my two little ones!)

Thanks again for your reply and would love to stay in touch on your progress.

[Brie]

My facial movement started almost 10 months out. I was told to wait until you have some return otherwise, it is not worthwhile (according to the facial therapist).