Facial Paralysis

woman smiling

Smiling is something that we often take for granted. There are thousands of expressions that a face can convey with inflections provided by a subtle lift of the eyebrow, a flared nostril, or a tightening of the jaw. Quite suddenly however, all of these expressions, as well as the ability to close the eye, speak, swallow, or even breath through the nose may be swept away.

When the facial nerve is damaged, one is left with functionally only half of a face. This critical window to the world becomes wooden and droopy on the damaged side. While some patients recover function on their own, many are faced with life-long paralysis. Social interaction is shunned, jobs are lost and relationships may be terminally stressed.

Traditional operations to repair facial movement require multiple stages with waiting periods of up to a year for nerve grafts to “take”. Others cause deforming contour abnormalities or give patients only static suspension. The facial plastic and reconstructive surgical team at UCSF is able to restore degrees of meaningful and expressive movement of the face. Droopy eyebrows are lifted, closure is restored to the upper eyelid, the lower eyelid is tightened and the smile may be restored with a muscle or nerve transfer. Progress in this area has been astounding, and continues with new techniques that are being developed at UCSF.

Facial paralysis is a devastating condition that compromises not only ones facial expressiveness, but one's entire persona. With a relatively simple operation consisting of a muscle transposition, patients can have symmetry restored and can even learn to smile again. It can be a truly transformative surgery and experience and we want to help you learn how to begin to smile again.

Facial Reanimation

Symptoms of facial paralysis may include:

  • Unbalanced or asymmetric facial structures
  • Inability to raise an eyebrow
  • Inability to close an eyelid and protect the eyeball from drying out
  • Looseness or sagging of the lower eyelid, leading to tears dripping down the cheek
  • Inability to raise, lower or pucker the lips, leading to dribbling when drinking and slurring of some words when speaking

The diagnosis of facial paralysis is often complicated. Facial paralysis may result from a disruption in the part of the brain called the motor cortex, injury to the facial nerve or damage to the muscles that control facial expression.

Diagnosis involves a consultation with a doctor, a complete physical exam and imaging studies of the brain and face. Your doctor may recommend one or more of the following imaging tests:

Complications affecting the eye are the most important concerns. The eye is constantly exposed to dry air and must be kept moist. Facial paralysis usually doesn't affect tear production, but it can affect the way the tears are distributed over the eye. There are many ways to prevent the drying effect, including taping, ointments, moisture chambers, patches and even temporary suture-closure of the eyelid.

Potential conditions that are examined before undergoing treatment include:

  • Bell's phenomenon, a condition that causes an upward and outward movement of the eye
  • Corneal anesthesia, which causes a lack of sensation
  • History of dry eye syndrome

To assess the facial nerves affecting the eyes, electromyography (EMG) may be performed.

Treatment of facial paralysis depends on many factors, including the patient's age, cause of the paralysis, severity of paralysis and duration of symptoms. Symmetry of facial features usually can be regained, if the patient participates in facial muscle retraining and therapy. Both are critical for success.

Drs. Knott and Park at UCSF's Facial Plastic and Reconstructive Surgery Clinic treat facial paralysis by transferring muscles and repairing blood vessels and nerves. The treatment is determined after the assessment of symptoms and is tailored to each patient's needs.

Treatment may include one or more of the following approaches:

  • Direct Reanastomosis or Nerve Graft — To help restore nerve function, surgeons sew together the severed ends of damaged nerves. If the ends of the nerves can't be sewn together directly, a piece of nerve is harvested and used as a connector or graft between the two ends.
  • Eyelid Procedures — Lower-lid tightening procedures and upper-lid weighting operations are used to treat eye conditions. Platinum or gold weights may be implanted under the skin of the upper lid to allow the lid to close passively with gravity. These procedures are usually performed in a clinic or procedure room.
  • Temporalis Tendon Transfer (T3) — The temporalis tendon connects the temple to the jaw and can be felt if the temple is lightly touched while clenching the jaw. Transferring the jaw tendon to the corner of the mouth can restore movement to the lips without altering the shape of the face.
  • 12-7 or 5-7 Nerve Graft — This procedure connects the hypoglossal nerve, a nerve leading to the tongue, to a facial nerve to produce nerve growth of the facial muscles. This may be performed within the first two years of nerve injury to maintain facial tone, and possibly regain some function. These grafts may also serve as "babysitter" grafts until cross-facial grafting may be performed.
  • Contour Restoration — Facial paralysis is sometimes a side effect of serious surgeries and can cause a change in the shape of a patient's face. Fat and tissue transferred from the thigh, a procedure called an anterolateral thigh free flap, are used to restore normal appearance. This type of "flap" is a microvascular reconstruction.
  • Botulinum Toxin (Botox) — During treatments to restore nerve function and growth, nerves can grow and branch into an unintended area of the patient's face, causing synkinesis, a combination of voluntary and involuntary muscle movement. For example, if a bundle of nerves designated for lip puckering also grows to the patient's eyelid, unintended eye movement may result during puckering. Some muscles can become hypertonic or overactive as a result of paralysis. Botox injections can be used to treat synkinesis and hypertonic movement by weakening specific muscles and thus restore facial symmetry. Brow ptosis, or a drooping brow, can be treated with botox injections or a brow lift.

To learn more about facial paralysis and its treatment and whether or not these procedure are right for you, please call us today to schedule a consultation. 

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Fax: (415) 885-7785

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