Facial nerve paralysis
Damage to the facial nerve may cause imbalance of the face at rest as well as distorted, asymmetrical facial expressions (e.g. smiling, laughing, grimacing, etc.). Functionally, facial nerve injury affects chewing, fluid retention while drinking, nasal breathing, corneal exposure, speech patterns, and communication skills. In children, facial paralysis most commonly occurs developmentally at birth or after brain tumor resection. Adults may experience complete or partial paralysis following an episode of Bell’s Palsy, acoustic neuroma, or traumatic injury.
At rest, the loss of facial muscle tone causes downward droopiness of the brow, eyelid, nostril, lip, and cheek on the paralyzed side of the face. The functional loss of of the dynamic muscles of the lip and cheek result in abnormal lip and oral function affecting chewing, retaining fluid while drinking, speech patterns and communication skills. Weakness of the circular muscles around the eye causes incomplete eye closure (lagopthalmos), excessive corneal exposure and tearing. Paralysis of the small nasal muscles cause collapse of the nostrils during breathing.
Perhaps the most devastating loss is the ability to smile. This is especially heartbreaking to younger patients and their families who are embarrassed by the loss of communication skills and whose self esteem is severely impacted by peer criticism.
The goals of successful facial reanimation include reestablishment of facial symmetry in repose and a spontaneous “natural looking” smile. Newer static procedures such as the fascia lata sling, pioneered by Dr. Rose, provide an “internal scaffolding” mechanism to support the corners of the lip and nostrils, balance the facial features, protect against corneal dryness, and create immediate facial symmetry in repose. To restore a smile, innovative micro-surgical procedures have been designed to recruit nerve impulses from branches of the normal facial nerve, re-activate dormant facial muscles or re-innervate substitute facial smile muscle.
Your first visit to New York City includes a comprehensive physical exam of your facial paralysis, EMG/nerve conduction studies to document nerve damage, and eye and speech evaluations to assess facial functional and expressive deficits. Detailed photographs and computerized imaging are used as a “blueprint” for the surgical plan of facial reanimation and to “preview” the post operative facial changes. Videotapes of you engaged in normal conversation and facial expressions are helpful in monitoring patterns of muscle use and smile configuration before and after your surgery. Our helpful office staff will assist you in hotel accommodations, travel arrangements, etc. during your visit to New York.
Surgery in children
Dr. Elliott Rose and his micro-surgical team at The Mount Sinai Medical Center in New York City, use cross facial nerve grafts (nerves harvested from an inconspicuous donor site on the calf) to “splice” into selected branches of the facial nerve on the normal side of the face. These grafts serve as a conduit for growth of the “electrical wiring” to the paralyzed side of the face.
In cases of recent injury, the re-innervated muscles are reawakened by in-growth of the new nerves. In long-standing cases of total facial paralysis, a second stage procedure is used to micro-surgically transfer a fresh muscle from the inner thigh to replace the paralyzed smile muscle and receive the nerve impulse from the cross facial nerve graft. Outcomes are not entirely predictable, but in almost all cases facial balance and symmetry is restored by the static re-suspension and a substantial degree of voluntary smile activity and facial expression is achieved.
Corrective surgery for Bell’s Palsy & Acoustic Neuroma
In adult patients, particularly those with partial paralysis (i.e. following Bell’s palsy or acoustic neuroma), a variety of static maneuvers restore more normal facial appearance. One stage regional muscle transfers from the adjacent scalp or neck are used to balance voluntary facial expression and restore a more even smile.
A more symmetrical face
Although there are no absolute guarantees, these procedures have been very successful in restoring facial balance and a more symmetrical facial expression to hundreds of patients who have come here from all over the country and the world. As you might expect, the results enhance the “quality of life” for children and adults alike. Facial expression, function, and communication skills that we all take for granted are dramatically improved.