What is facial nerve palsy?
Facial nerve palsy is a paralysis of the facial nerve that can occur on one side or both sides of the face. Facial nerve palsy can occur suddenly and “idiopathically,” or it can result from trauma or following tumor surgery. The nerve paralysis causes the facial muscles to become flaccid, resulting in drooping of the lower eyelid and the corner of the mouth, as well as an inability to smile or pucker the lips. In addition, hearing, taste, and tear and saliva production may be affected.
The cause of idiopathic facial nerve palsy often cannot be definitively determined. Insect bites, inflammation, and circulatory disorders (e.g., stroke) can cause it. In approximately 80% of cases, this type of paralysis resolves completely.
“Peripheral” facial nerve palsy involves paralysis of the facial nerve without involvement of the forehead. The cause is either an accident (trauma) resulting in a facial skull fracture within the nerve canal or a tumor in the cerebellopontine angle. The paralysis may result either from pressure exerted by the tumor on the nerve or following the tumor’s removal. In most cases, the paralysis is not expected to resolve.
If facial nerve paralysis shows no signs of resolving on its own, surgical treatment is necessary. This is intended to restore facial muscle function; however, it has no effect on impairments of hearing, taste, or tear and saliva production.
Information on the surgical procedure
In reconstructive substitution procedures, a distinction is generally made between statische and dynamic procedures.
In the case of statischen procedures, the body’s own tissue is used to restore the supporting function of the eyelids and the corners of the mouth
The dynamic Reconstruction is achieved through a nerve graft from one side of the face to the other. Additionally, a muscle graft may be performed to restore impaired muscle function. With several months of rehabilitation, particularly in younger patients, a promising reconstruction can be achieved.
Another option for dynamic reconstruction is a nerve anastomosis with a healthy existing nerve on the affected side (babysitter nerve). A functioning nerve that does not belong to the facial nerve group is microsurgically connected to a paralyzed branch and, after a period of time, provides motor innervation to the affected nerve. Often, several surgical procedures are combined.
Die dynamische Rekonstruktion nach Gillies and McLaughlin durch Muskeltransposition sind ebenfalls adäquate und erfolgversprechende Operationsmethoden.
The McLaughlin dynamic reconstruction is used to restore function to the mouth. To achieve this, the coronoid process of the mandible—where the temporalis muscle attaches—is severed. A tendon strip from the forearm or thigh is threaded through a drill hole in the coronoid process. The tendon strip is pulled toward the mouth and anchored at several points. This allows the patient to smile by activating (biting down on) the temporalis muscle.
See picture
Summary of Reconstructive Options
Eyes:
- Tarsorrhaphy
- Mediale Kantopexie der Augenwinkel
- Muskelersatzplasik nach Gillies
- Lifting the lower eyelid with a cartilage graft
- Botox Therapy
Face:
- In cases of recent trauma: microsurgical reconstruction
- Muscle replacement plasty using the temporalis muscle (according to McLaughlin)
- Cross-Face Nerventransplantation
- Nerve coaptation to the masseteric nerve (babysitter nerve)
- Microsurgical free muscle graft
We would be happy to discuss the surgical technique best suited for you during a personal consultation.
Hospital stay and anesthesia
Most procedures are performed under general anesthesia. Depending on the extent of the procedure, an inpatient stay of 4 to 6 days is required.
After the surgery, facial swelling will be noticeable, which will subside over the next 4 weeks. However, the final result is not expected until approximately 6 months later. Immediately after the surgery, muscle exercises may be necessary.
Despite the utmost care, surgeries always carry risks. For example, due to the large wound areas, bruising or even postoperative bleeding may occur. Inflammation of the wound areas and resulting wound healing disorders may also occur. The scars and the surgical area may have reduced sensation after the procedure. This typically returns to normal within the first 8 weeks. Minor asymmetries or unsightly scars can be corrected during a subsequent outpatient visit.
We would be happy to consult with you in person during our consultation hours.