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Rehab specialists complete the picture

“Nobody gets to be a cowboy here,” says one facial reconstructive surgeon in the Department of Otolaryngology.

Helping people live with dignity and perform the most basic of functions, like swallowing, smiling, or talking, demands that you rely on those around you to support and complete your work.

Peter Hilger, M.D., does complex facial reanimation surgeries to give people the ability to communicate, to express emotions, to be part of the world again. But he knows that he can’t do this alone.

“I couldn’t take on the patients I do without someone like Cindy Landis,” he says.

Landis, a speech-language pathologist, describes herself as a “personal trainer for people’s faces.” At the Facial Paralysis Clinic at University of Minnesota Medical Center, Fairview, she works with physicians to evaluate patients and manage their rehabilitation, including designing treatment approaches for regaining control of facial muscles and expressions.

Landis founded the clinic in 1998 with physical therapist Jill Fahnhorst. Combining techniques from their disciplines brought a unique approach to the treatment of facial nerve disorders, and the clinic is one of very few facial paralysis treatment centers across the country.

“Rehabilitation can’t restore the nerve damage causing paralysis,” says Landis. “But it improves muscle control and strength and reduces the synkinesis (unwanted facial tightness or movements) that leads to involuntary movements, like eye closure when smiling, talking, or eating.”

Retraining muscles can be a painstaking process. Rehabilitation typically includes in-clinic and at-home practice programs. Therapists use sensorimotor feedback methods, mirror exercises, massage techniques, and slow, controlled movement patterns to guide patients toward target facial postures.

“I give them the tools, but the patients do the work,” says Landis. “[Rehabilitation] is a team effort among the physician, the patient, and the therapist.”

For example, Hilger may move or splice nerves so a person can smile by placing his tongue behind his front teeth on the roof of his mouth, as in saying the letter “N.” Landis will then work with that person so gradually he can smile without using his tongue to make it happen.

Landis also is having success with patients who are not candidates for surgery—for example, people who have had Bell’s palsy, Lyme disease, facial trauma, or other causes of facial nerve injury.

“People don’t realize how fatiguing it can be to talk when half your face isn’t working,” says Landis. “Or imagine drinking and having things spill out of your mouth. It’s very rewarding to help people adjust to a difficult situation and be able to do something about it themselves.”

By Martha Coventry

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