Brain mapping of the cortical representation of facial movements in patients with congenital facial palsy undergoing surgical procedures of facial animation

Moebius’ Syndrome is a congenital condition of aplasia of facial and ocular muscles and of the relative nerves. Its symptoms are: bilateral facial palsy and horizontal gaze palsy, which are present at birth and persist non progressively throughout life. The absence of facial movements may be compensated by the surgical procedure of “facial animation”. This consists in the implant of a muscular flap obtained from the gracilis muscle that is reinnervated over a few months by the massetric nerve, thus making voluntary facial movements possible. This project starts from the utter lack of information o how the brain controls a new movement such as the facial one, of which it has no previous experience whatsoever. It is possible that the between-subject variability in how proficient a patient becomes in controlling facial movements may be in part due to the variability in the way the brain embeds the new movement in its repertoire. The Telethon grant will be used to investigate with non-invasive techniques the cerebral activity occurring during voluntary movements in post-operative patients and correlate it with the actual subject’s capacity to move the face. The endpoint will be that of describing what pattern of cerebral activity better correlates with and predicts dexterity in facial movements. In order to map non-invasively the brain activity of patients during the execution of facial movements, we will use cutting-edge technologies such as magnetoencephalography and functional magnetic resonance imaging. Our short-term perspective is to better understand the effects of surgical treatment of Moebius’ Syndrome at the level of the central nervous system because even in presence of perfect surgical procedures, failure of the brain to control the new effector will give sub-optimal results. In the long-term the objective is to produce data that will allow to better select patients for surgery and to guide post-operative efforts in rehabilitation and speech-therapy.