FIRST QUARTER 2001, VOLUME 15, NO 1

Restoring appearance and function with facial paralysis

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Restoring appearance and function with facial paralysis

Think about how devastating it would be if you were unable to smile or show any facial expression. Facial weakness or paralysis is due to disorders of the facial nerve; disorders can be caused by tumors, trauma, or unknown conditions (e.g., Bell’s Palsy). Your facial plastic surgeon, specializing in head and neck surgery, has specific training and experience in managing facial nerve disorders and can provide the appropriate diagnosis and treatment, which are very important for optimal recovery of facial nerve function.

What is the facial nerve? It is comprised of 7,000 individual nerve fibers that carry electrical impulses to facial muscles, tear glands, saliva glands, the middle ear, and taste buds. Information that is passed through these fibers allows us to smile, frown, laugh, cry, and taste. When the fibers are irritated, movements may appear as spasms or twitching; when half or more of the nerve fibers are severed, facial weakness can occur. Due to the complexity of the facial nerve, disorders may result in twitching, weakness, or paralysis, dryness of the eye or mouth, or disturbance of taste.

Each individual with facial paralysis requires a detailed analysis of deformities and concerns in order to plan for reanimation. Facial paralysis, usually affecting one side of the face, can cause problems of the eyebrow, eyelid, cheek muscles, and mouth. Even patients with permanent facial nerve injury, however, can improve function and appearance with facial reanimation surgery.

A brow lift procedure can be performed to elevate the eyebrow and eliminate any sagging that is pushing on the eyelid tissues. Once the eyebrow is raised, blepharoplasty (surgery of the eye) removes any excess skin and muscle from the upper lid so it does not block the peripheral vision. If there is difficulty closing the eyelid, a gold weight can be implanted into the lid to close whenever the muscle relaxes. A lower lid blepharoplasty can correct any droopiness by removing lax skin or muscle. In cases where there is involuntary eyelid closure or spasms (blepharospasm), botulinum A toxin, or Botox, injections may be used to relax those muscles. Patients who have diminished blinking or the absence of tearing must use artificial tears or lubricating ointments to ensure that the eyeball stays moist.

Implants may be used to fill a depression where muscle tissue has atrophied or been removed from the cheeks. A temporalis muscle transfer which can provide mobilization and nerve stimulus to the mouth. This technique involves repositioning healthy functioning muscle from the side of the head to the corner of the mouth and/or the eye. The problem is intentionally overcorrected because the resulting pull weakens over several weeks. This leaves significant and long-lasting improvement in symmetry as the patient learns to control the mouth or blink the eye again.

As you can see, there are various options to restore function and appearance. Therapy can include one or any combination of procedures. If you have any questions regarding rehabilitation or think you may be a candidate for the above mentioned treatments, contact your physician. We want to see you smile.