We wish to show a series of patients who had facial reanimation with free gracilis innervated by the nerve to the masseter. Each one demonstrates a different degree of cortical plasticity. The first patient will not have any plasticities as they are shown within one year of the initial operation. Give me a big smile. Smile as much as you can. There you go. Show me your teeth Jonah. Yeah, good job. Now I want you to smile with your teeth closed. Bite down. Yeah. Do that again. Yeah. Big smile. Yeah, that's great Jonah. Perfect. Perfect. Alright. We now wish to introduce another young lady with right facial paralysis innervated using nerve to masseter to the free gracilis. And slightly put them apart. Don't clench them. I'm going to have you show me a smile with your teeth apart a little bit, okay? There you go. Smile. Now go ahead. There you go. Smile. Keep looking here. There you go. There you go. There you go. Relax it. Good. Now what I'm going to have you do is I'm going to have you close your teeth again together like this. And I'm going to have you show me a closed mouth smile. So just keep your lips together and go. That's perfect. One is this young girl within one year of the operation. She now can smile with biting but has not yet developed corticoplasticity. Can you smile for us please? Okay. Okay. Good. Can you laugh? He he he. This young lady now returns 13 years later at age 21. She is able to smile without making a voluntary effort to bite. And when she does bite, she can strengthen her smile further if she wishes to do so. This demonstrates the corticoplasticity that has developed during her childhood. Juliette, can you tell me your name and where you're going to college? Sure. My name is Juliette and I'm currently going to Cleveland State University for biology. Thank you. So I'm going to ask you Juliette to open your mouth and show us your teeth. Now I want you to smile but don't bite down. Now I'd like you to bite down while you're smiling. Now I'd like you to relax, but show your teeth. No, don't smile. And now bite down. Okay. Again bite down. Don't smile. Okay. Thank you. Now I'm going to ask you to do the same with your mouth closed. Now I'd like you with your mouth closed. I'd like you to smile, but don't bite down. Now I want you to bite down while you're smiling. Okay. Now I want you to relax with your mouth closed. And I want you to bite, but don't smile. Thank you. The next young lady presented with bilateral Mobius syndrome and bilateral facial paralysis. She was innervated sequentially with a free gracilis innervated with the nerve to the masseter, each spaced a year apart. She is first shown prior to any operation. Smile with your mouth closed. Okay. As big as you can. Smile with your mouth open. Stick out your tongue. This young lady is now shown four years later. We find that she has demonstrated significant corticoplasticity and she can bite without smiling and smile without biting. Okay, good. Teeth together. Give me a big smile. Good. Now, with your mouth open, with your teeth apart, I want you to give me a big smile. Excellent. I want you to bite down real hard.

facial paralysis

cortical plasticity

gracilis muscle

Mobius syndrome

smiling exercises