Injury to the facial nerve is a common clinical problem. Common causes include Bell’s palsy, surgical trauma, and involvement with benign and malignant neoplasms. The movement impairment that follows facial paralysis affects eye protection, nasal breathing, speech and the ability to smile. Our goal for all patients with facial paralysis is to restore movement to the face that is controlled, symmetric and spontaneous.

Treatment options offered in our practice for facial paralysis 

Neuromuscular reeducation (therapy): working with our specially trained physical therapist, specific facial exercises one can relearn to cmove the face by suppressing unwanted movement while enhancing desired facial movement. This therapy is aided by video recording of desired facial movements such as a learned smile in a system known as self-modeling and social implementation.

Targeted Botox injection

Botox injected in specific muscle groups helps correct the assymmetry in the face and is also used to facilitate physical therapy 

Static reanimation ( facelift, eyelid sling, midfacelift, Fascia lata slings)

The droopiness seen in the paralyzed face can be corrected with various procedures that even out the face and actually helps the face look younger. 

Dynamic reanimation procedures ( temporalis tendon transfer, masseter muscle transfer, diagastric muscle transfer).

With a special and minimally invasive technique that we have helped advance, we are able to restore movement to the face  and allow one to relearn the ability to smile. This is one of the most rewarding procedures we perform for facial paralysis because the result is almost immediate. infact, with muscle stimulators, we can record movement of the face minutes after the procedure is completed. The patient then learns to harness the power of the transfered muscle for smiling.

Nerve grafting ( facial nerve-hypoglossal nerve, facial to facial nerve grafting).

Whenever feasible, we try to reconnect the injured nerve either directly or by using nerve grafts harvested from the neck or leg. It usually takes 6 months to see results but the outcome continues to improve over several years. 

Free muscle transfer .

When nerve repair or muscle transfer is not feasible, we have the option of transferring muscle  and nerve from the leg to the face, connect the nerves to other nerves in the face to allow facial movement.

 Patient with a history of acoustic neuroma surgery. She had no return of facial nerve function after 18 months of observation. She underwent facial nerve to partial hypoglossal nerve grafting using a nerve graft. The temporalis muscle tendon was transposed fron the coronoid process of the mandible to the nasolabial crease through a small 2 cm incision in the crease ( minimally invasive temporalis tendon transfer). Nine  and 12 month post-operative pictures are shown here. Notice the improved brow symmetry. A browlift was not performed. She also has improvement in eye closure and lower eyelid position after a lower eyelid fascia sling procedure. Her nasal breathing has improved. Also notice the enhanced symmetry of the lower face at rest and during a controlled smile. She now has a more defined neck line with no jowling. She has excellent tongue movement. Patient directed neuromuscular re-training ( physical therapy) is an important part of our facial paralysis rehabilitation protocol.

 

 

 

33 years old male who underwent radical parotidectomy with total facial nerve resection for malignant parotid tumor. The facial nerve was repaired by a hypoglossal to facial nerve grafting in an end to side manner. Results shown here at 8  months post-operative visit. Note complete eye closure and near symmetric smile. The tongue function is unimpaired.	Facial nerve repair by nerve grafting