When should patients after hypoglossal-facial-jump nerve suture start with the exercises? How should the treatment be structured? And which exercises are most effective?
neuromuscular retraining needs to be started after facial tone is achieved and the nerve graft has been activated. hypoglossal facial nerve transfer can lead to synkinesis so part of the retraining is preventing synkinesis and also helping patients thrust their tongue to mimic a smile.
After the patients became able even to do a little movement a mirror can be useful for feedback. You can base part of the rehabilitation treatment in biofeedback. You can order many differents exercises and a mirror is very useful for the patient to know if he or she is doing well it. Good luck!
Physiotherapy can start when the first muscular contraction is noticed. Time for this to occur ranges widely, from just over 1 month to 6 months. Once this occur, apart from strengthening the excursion, the most important aspect of physiotherapy is to prevent or suppress synkinesis.
These goals can be achieved by exercises such as swallowing with abduction of oral commissures, mirror therapy, and smiling with tongue pressure.
Thank you for your answers!
What do you think about a kind of mental training in order to bridge the time until occurrence of first movements.
I think it is important to warn the patients that some of them will never get any excursion back. Some of my patients find chewing gums useful, but I'm not sure if it actually helps.
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