Huey is a talented 8-year-old hunter who abruptly began showing neurologic signs, including gait deficits and paralysis of the nerves innervating the right side of his face. As a result, he was unable to be ridden and had difficulty eating. He was diagnosed with EPM and was treated with oral medication. His gait deficits slowly improved and he was able to start back under saddle, but he continued to suffer from facial nerve paralysis. After six months, he still could not eat hay and was only able to take in soupy feed. He came to VRSVA to see if we could help!
When Huey arrived, we noted pain over his right temporo-mandibular joint (TMJ). He had visible paralysis of his lower lip and had no sensation over his right nostril or right lower lip. His right masseter muscles were atrophied or wasted away and his left masseter muscles were hard and painful. He was barely able to open his mouth.
We got right to work on Huey’s treatment plan. Treatments included TMJ injection, Class IV laser therapy, TENS therapy, deep massage, gentle stretching of the jaw with an oral speculum, therapeutic ultrasound and physical therapy exercises to encourage Huey to work his lips and the muscles associated with chewing. We also used a trial therapy (Sonotron) licensed in Japan for TMJ pain. We were giving it our all!
Within two weeks, Huey had made significant progress! Comfort over his right TMJ had improved and he could open his mouth wider. He was able to eat chopped alfalfa forage and hard treats. By the third week, he could open his mouth twice as wide without signs of pain. His masseter muscles were starting to show signs of developing and he had regained sensation over his nostril and lip, indicating some regeneration of his facial nerve.
Huey was able to be sent home at this point to continue physical therapy with his owners. They were given a number of exercises and activities to perform regularly to help Huey continue to progress. Huey will likely never return completely to normal, but he has continued to improve at home and can eat well and open his mouth to have a dental. He is happy and back to work and we are so happy for him!
Huey: Rehabilitation After Facial Nerve Paralysis
Here is a video of Huey during a TENS (transcutaneous electrical nerve stimulation) unit therapy session. This machine works by sending stimulating pulses through the skin to underlying nerves. It can help with pain relief and can also help stimulate nerve regeneration.
This was an exciting day for Huey! When he arrived, we could barely open this speculum to the first notch under heavy sedation. Here he is after two weeks of rehab open to the second notch without any sedation or pain medications! Most horses can easily open to the third notch.
