Welcome to The Center for Facial Recovery’s™ Frequently Asked Questions and some answers to help you move forward with effective facial paralysis and TMD / TMJ treatments that are just right for you. The following Q&A is meant as a beginning to spark a dialogue that will lead to getting the treatments you need to recover.

THE CENTER FOR FACIAL RECOVERY™ ANSWERS:

What is The Center for Facial Recovery™ all about?

Making a difference through knowledge, compassion and dedication.  For many years we have treated patients that had to take a very long road with many detours to find the care they needed and deserved. It was our passion to open a center that was dedicated to the treatment of patients with facial weakness / abnormal movement, TMJ pain /dysfunction and abnormal posture/ neuromuscular imbalances. The opening of this center is in dedication to all of our patients. Our promise to you is we will be 100% committed to your recovery and provide you with the education and skills you need to understand and manage your symptoms.  At the Center for Facial Recovery™, you are the center of your recovery. We will educate you in your condition, treat your symptoms, listen to your concerns, and look beyond your diagnosis to be able to treat the whole person.  Our toe to head approach of symptom analysis allows us to use our skilled, hands-on techniques to provide you with the highest quality of physical therapy care.  Working with patients on their road to recovery is our passion. We are clinicians who learn more and more every day from our patients which allows us to provide very dynamic and unique treatment protocols.

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Does The Center treat all kinds of facial palsy, or does it specialize in certain conditions?

The Center for Facial Recovery™ provides comprehensive facial palsy treatments, regardless of the cause. In addition, we specialize in the treatment of TMD, headaches and postural related dysfunctions.

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What’s so special about the “team” and “coordinated” approach that The Center touts?

So many of our patients come to us having wandered through a complex, confusing and splintered health care system, getting mixed messages about the best treatments. They have to coordinate multiple treatment providers and ensure that medically relevant information is being shared among providers. At The Center for Facial Recovery™, we take a different approach. We believe in bringing a team – your team – together around what you need for your particular situation, that team develops a treatment plan just for you, and we coordinate your treatments every step of the way.

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Do I have to come into The Center’s office to get treatment?

We highly recommend for all initial visits to be conducted at our office specifically designed with you in mind. We provide flexible treatment times and days to meet the needs of your schedule. But we are a Center with national and international reach  using virtual technology which includes at-home therapeutic devices and even a mobile app to encourage patients to complete their therapy.

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Why does it seem that surgery is the only option, because that doesn’t seem to be the case at The Center?

If you’ve been doing research online or talking with various physician practices, you probably have gotten the impression  that you either have to live with what you have or opt for surgery.  The difference at The Center is that we maximize recovery through applying innovative, proven treatment techniques. However, if surgery is the best option for you, we have  surgeons specifically trained and experienced to treat your condition  with which we can coordinate your care.

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What is the cost of treatment?

The cost of treatment is tied directly to each patient’s individualized treatment plan. The Center has chosen to practice independently of managed healthcare networks. This allows us to offer appropriate time to fully examine, discuss all aspects of your disorder and maintain a high quality of care. We do, however, believe in holding down costs in order to increase access to the level of care our patients have come to need, expect and deserve.

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Is treatment covered by insurance?

It depends on your personal insurance plan so you should check with your health plan carrier. We have provided a document to assist you with determining your insurance benefits for physical therapy. Most plans do cover treatment, typically up to 80%. At the Center for Facial Recovery™, our patients pay for treatment directly, and our administrative support team will provide you with the necessary documentation to submit your claim. Please click here for an Insurance Worksheet to help guide you through the process.

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GENERAL TREATMENT ANSWERS:

What’s the most important thing for a facial palsy patient to do first? 

Be evaluated by your physician! According to May and Schaitkin, doctors and authors of  The Facial Nerve, there have been 113 different causes for facial weakness identified in the literature. It is essential to receive a quick and accurate diagnosis. This will allow your medical provider (neurologist, ENT, primary care or ER doctor) to initiate the correct plan of care.

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GENERAL TREATMENT ANSWERS:

What is facial palsy?

Facial palsy occurs when there is damage to the facial nerve (Cranial Nerve VII).  This results in loss of facial movement controlling expressions.  In other words, it causes the nerves, typically on one side of the face to stop working, making it difficult to close one’s eye, smile, or even drink from a cup or straw. It can be very debilitating mentally and physically.

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What causes facial palsy?

There is no single definitive cause of facial palsy and can be a result of varying factors, such as:

● Viral infections such as Bell’s palsy (Herpes Simplex) and Ramsay Hunt (Herpes Zoster) syndrome

● Damage to the nerve as a result of surgery

● Bacterial causes such as Lyme Disease or following a middle ear infection

● Neurological conditions such as Neurofibromatosis 2, or Guillain-Barré syndrome

● Traumatic injury to the brain, skull or face

● Birth trauma

● Congenital conditions

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What are the signs of Bell’s Palsy?

Cardinal signs of Bell’s palsy include, but are not limited to, facial weakness or unilateral paralysis, dry mouth and/or eye, and problems tasting. These symptoms can occur suddenly, in as quickly as 24-48 hours. Many people experience severe pain behind their ear or in the back of their head several hours prior to the onset of facial weakness.  Because these symptoms are the same as in other conditions, it is imperative that you see your physician immediately.

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What is the cure rate for Bell’s Palsy?

Without intervention, 71% of Bell’s Palsy patients have a complete recovery after 1 year, 13% have a slight residual weakness, and 16% have fair to poor recovery (Peitersen, 1982).  Research has not been able to determine why some patients recover and some do not.  At The Center, we educate you at the onset of symptoms  and then initiate interventions to give you the best opportunity for full recovery.

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How is Bell’s Palsy Treated?

The advantages to early intervention are patient education in eye care, understanding the disease process, and initiating  home exercises.   At The Center for Facial Recovery™, we specialize in the treatment of those patients who have been identified as “fair to poor” recovery. Our individualized treatment programs include a comprehensive approach utilizing manual therapy techniques, Mirror Book™, Graded Motor Imagery, Biofeedback, Dry Needling and Neuromuscular re-education.

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What is the Prognosis?

The prognosis for individuals with Bell’s palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal function within 3 to 6 months. For some, however, the symptoms may last longer. In a few cases, the symptoms may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.

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Where can I get more information about facial palsy and Bell’s Palsy specifically?

http://bellspalsy.org.uk
http://www.sircharlesbell.org
http://www.anausa.org
http://www.ninds.nih.gov/disorders/bells/detail_bells.htm
http://www.bellspalsy.ws/treatment.htm
http://www.ramsayhunt.org

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN P.O. Box 5801 Bethesda, MD 20824 www.ninds.nih.gov

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GENERAL TMJ ANSWERS:

What can you tell me about TMD?

Disorders of the temporomandibular joint have been reported as far back as the ancient Egyptians. Problems with the TMJ are known as temporomandibular joint disorder or dysfunction (TMD). TMD is very common; according to the U.S. Department of Health and Human Services, there are over 10 million Americans affected by this disorder.  TMD symptoms include jaw pain, jaw fatigue, difficulty opening your mouth to eat, talk or yawn, ringing in your ears/or cloudiness, dizziness, headache, popping or clicking sounds in your jaw, facial pain, tooth pain, pain behind the eyes and even neck pain or shoulder pain/weakness.

TMJ is a Synovial (Gingylmo-Arthrodial) Joint

  • When the mouth opens, two distinct motions occur at the joint.
  • The first motion is rotation around a horizontal axis through the condylar heads. (Arthrodial motion)
  • The second motion is translation (slide/glide). The condyle and meniscus move together.

What is another Gingylmo-Arthrodial Joint in the body? The first metatarsophalangeal joint ( your big toe) is ginglymoarthrodial.  We don’t think this is a coincidence which is why we practice Toe to Head evaluation when looking at patients with TMD symptoms.

tmj.jpg

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What causes TMD?

Bad posture habits. One of the reasons TMD is so common is because many of us spend a great deal of time sitting at a desk, where we often hold our head too far forward as we work. This puts a strain on the muscles, disk, and ligaments of the TMJ.

Stress.  Which can cause chronic jaw clenching at night(“bruxism”) and muscle tension/spasm

Problems with teeth alignment(“malocclusion”). If your teeth come together in an unusual way, greater stress is placed on your TMJ.

Fracture. In a traumatic accident involving the face or head, a fracture to the lower jaw may result, and even when the fracture is fully healed, TMJ stiffness and pain may remain.

Surgery. Following surgery to the face and jaw, there may be a loss in mobility and function of the TMJ.

Trismus (“lockjaw”). This condition—where jaw muscles spasm and the jaw cannot be fully opened—can be both a cause and a symptom of TMD. Other causes of trismus include trauma to the jaw, tetanus, and radiation therapy to the face and neck.

 Whiplash injury such that occurs in a car accident or from a concussion.

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How is TMD treated?

Postural evaluation is a key component to our assessment and  treatment of TMJ disorders. What makes our approach different is that we understand the body is a chain and that a kink anywhere along the chain needs to be addressed or you will never achieve lasting relief. We start at your feet and work all the way up to your jaw.  With this approach , we work very closely with our team of dentists and podiatrists to allow for biomechanical alignment and symptom management.

Manual Therapy techniques are utilized to improve joint mobility in the spine and jaw region and decrease muscle spasm for successful pain relief.

Neuromuscular retraining. Muscles have memory, and many times for those patients who have been in pain those muscles have “bad” memory.  Our program retrains muscles and the brain to remember what it is like to move an area correctly without pain.

Modalities such as dry needling, PENS™, ultrasound and electrical stimulation.  We work very closely with your dentist or can recommend one for management of a proper oral device to assist with reduction in your symptoms.

Click here for more information about TMJ

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COLLABORATION WITH OTHER SPECIALISTS:

Who are some of the other doctors with whom you collaborate?

Dr. Victor Ibrahim

Dr. Michael Reilly

Dr. Steven Davison

Dr. Michael Singer

Dr. Kevin Schwartz, et al

Dr. Bernard Greenbaum

Dr. Debbie Lin, et al

Dr. Richard Redett

Dr. Dallas Lea

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