Facial nerve paralysis results in significant cosmetic and functional disability. The paralysis can be temporary or permanent and is due to damage to the Facial Nerve. This can originate in the brain, through the skull base, parotid gland or in the lateral face under the skin and muscles eg:
- Viral infection - Bell's Palsy, Herpes Zoster (Ramsay Hunt Syndrome)
- Tumour surrounding the Facial Nerve - Cerebropontine Angle (Acoustic Neuroma / Vestibular Schwannoma, Meningioma), Parotid Gland Cancer
- Surgical Resection of the above tumours
- Trauma to the brain, skull base, parotid gland or face
- Cerebrovascular Accident / Stroke
- Congenital
- Unknown
Options for reconstruction of the paralyzed face include both dynamic and static procedures; and the goals are:
- Functional: eye protection, re-establish oral competence, speech and nasal airways
- Cosmetic: facial symmetry at rest, voluntary and spontaneous facial movements, absence of synkinesis
Dynamic procedures are the treatments of choice and these include nerve repair, nerve substitution, and muscle transfer. Static procedures are indicated in the management of the eyes, re-establishment of facial symmetry and cosmesis and provide an alternative to dynamic reconstruction in selected patients.
Dynamic Procedures
Repair of the Facial Nerve is the most effective procedure and is indicated in neurolysis. Immediate repair is critical; however repair up to 2 years can still be achieved if no irreversible distal neurofibrosis and myofibrosis have occurred.
Nerve Substitution is used when the proximal nerve segment is sacrificed but a distal neuromuscular pathway is present. A donor nerve "powers" the facial musculature in place of the injured facial nerve.
Patients with chronic, congenital or developmental facial paralyses have inadequate distal neuromuscular units making reinnervation impossible. A new neuromuscular unit is transplanted into a region of the paralyzed face.
Regional muscle transfer, usually the
temporalis muscle, is used to reanimate the lower third of the paralyzed face.
Static procedures
Management of the eyes is critical as facial palsy can result in incomplete eye closure, ectropion, brow ptosis, decreased tear production which results in exposure keratitis, corneal ulceration and blindness. Most dynamic procedures do not provide adequate reanimation and eye protection. Static techniques are utilized and they include
gold weight insertion on the upper lids, lower lid shortening or
tarsal strip canthoplasty and (least preferred)
tarsorrhaphy.
For the lower third of the face
static suspension by a sling can re-establish facial and lip symmetry and improve oral competence. The alternative is an
endoscopic assisted subperiosteal face lift and suspension which is the preferred technique.
Septo-rhinoplasty may help with airway obstruction and nostril deformities due to collapse of the nasal valve and nostrils.
Other adjunctive cosmetic procedures including
browlift, blepharoplasty, and rhytidectomy (facelift) can be combined to address the specific soft tissue changes.
Finally, the use of
botulinum toxin injections, selective myectomy or neurolysis after reinnervation techniques can be beneficial in the treatment of synkinesis or hypertonia.
Fees & Insurance
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