Most patients who experience Bell’s palsy can make a full recovery. However, this isn’t the case for everyone. About 30% of patients will suffer from neck and facial tightness and synkinesis and will develop chronic facial palsy.
Other conditions, such as Ramsay Hunt syndrome, facial nerve repair, acoustic neuroma resection, and trauma can also create synkinesis and facial tightness. Chronic facial paralysis occurs when the facial nerve recovers abnormally.
Understanding Selective Denervation
Selective denervation is a surgical procedure. It can improve facial tightness, facial symmetry, and the smile in some patients who experience chronic facial paralysis. This is done by mapping out all branches of the facial nerve, removing the ones that innervate the muscles that prevent a smile and those that create synkinesis.
Through the selective denervation process, patients have the chance to restore a spontaneous and balanced smile. The surgery can also help relieve some facial tightness associated with most patients who have chronic facial paralysis. If this is something you are interested in, speak to a facial nerve specialist to determine whether it is the right procedure for you.
What Occurs During Selective Denervation
Patients undergoing selective denervation will first be put under general anesthesia. An incision will be made on the affected side and about 10 to 20 nerve branches will be identified using intraoperative nerve stimulation.
The facial movements associated with individual nerve branches are mapped out so the surgeon can easily determine which can be removed to improve facial symmetry and smile. These will be resected while the other nerve branches are preserved to ensure good facial movements.
After the procedure is complete, most patients will go home the same day. Some will spend one night in the hospital. Many patients will notice improvements on the first day following selective denervation. Others may need to work with a facial nerve therapist for a few months to experience optimized facial symmetry and movement.
The Recovery Process After Selective Denervation
Most patients who have selective denervation will experience some amount of swelling. It tends to peak at about three days after surgery before gradually improving. The major swelling will improve over two to three weeks but residual swelling may be present for up to four months.
To avoid increased swelling, there are several things you can do. This includes sleeping with the head elevated, icing the face for a week, and avoiding heavy lifting or strenuous exercise for about two weeks.
As with swelling, bruising can vary from one patient to the next. Most discoloration and bruising will fade within three weeks. At five days or longer after the surgery, arnica gel can be used on the bruised areas, but avoid incision lines. Your surgeon will provide you with post-operative instructions to follow.
It is important to realize that this operation is still new and under development. Selective denervation may improve the smile function, but as many as 25% of individuals may experience some loss of oral competence as a result.