Initially after facial nerve injury, the facial muscles become flaccid and you have no control over them. They may feel loose and floppy with no muscle tone at all. As the facial nerve regenerates, muscle tone may return, and one may feel there is some movement returning. Sometimes the muscles can become very tight, or cramp like. One may report feeling more tightness, stiffness, numbness, or even discomfort, tenderness or pain. Any muscle that is tight, restricted, tender or painful is going to limit how that particular muscle contracts and relaxes. In addition, muscles on the unaffected side of the face may also become tight and painful as they are now working harder to produce facial expressions and communicate meaningfully during the day. Like any other muscle that is tight or painful, If a facial muscle is not contracting or relaxing well, this is going to have a huge impact on how the facial muscles interact to create a smile, a pucker or other expression.
A detailed evaluation of facial expressions as well as a thorough palpation of the facial muscles will assist in determining the state of the facial muscles. Included in the evaluation are details of whether muscles are seen contracting to create an expression, whether other facial or neck muscles are overworking to help out another muscle in an expression, the presence or absence of synkinesis, tender or painful points in the muscles, as well as muscle size, thickness and texture. Many people are unaware that their facial muscles are tight and even painful until pressed upon in the right spot. This must be addressed to enable a return of controlled movement of the face and symmetrical expressions.
Based on the results of a thorough evaluation, the most appropriate massage and stretch techniques can be applied to the face. Each technique is modified to each individual according to their needs. It’s most beneficial to instruct and teach clients to do the massages themselves in order that treatment is performed consistently a daily basis. The more one is aware of the state of their facial muscles, the more they can learn to facilitate facial muscle relaxation and precise contraction, which is integral to gaining back that smile and other facial expressions that one yearns for in social communication.