Aberrant regeneration of seventh nerve may occur following a facial nerve palsy in which the lower branches of the nerve can grow to re-innervate orbicularis oculi resulting in ptosis with movement (or even resting tone) of the muscles of facial expression of the lower face.The ptosis which develops following a facial palsy; when the patient moves the lower facial muscles, for example, blows out the cheeks or simulates chewing, the upper lid droops. Abolition of the ptosis requires division of the levator muscle and brow suspension or levator transposition. The aberrant activity in the facial nerves may be reduced with cautious botulinum toxin injections to the orbicularis muscle.
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