Facial paralysis can occur in both adults and children. In children, it is usually the result of developmental birth defects or after brain tumor resection. Adults may experience complete or partial paralysis after Bell’s palsy, acoustic neuroma, Lyme disease or traumatic injury. The loss of facial muscle tone results in a downward droop of the brow, eyelid, nostril, lip, and cheek on the side of the face that is paralyzed. When the dynamic muscles of the lip and cheek are compromised, the result is abnormal lip and oral function that affects chewing, retaining fluid while drinking, speech patterns, and communication. Weakness of the circular muscles around the eye causes incomplete eye closure (lagopthalmos), excessive corneal exposure and tearing. The most devastating loss is the ABILITY TO SMILE. This distortion can severely impact self-esteem and cause embarrassment.
Your first visit 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.
The goals of successful facial reanimation include restoring the symmetry of the face and active facial motion. Dr. Rose has pioneered a new procedure using the fascia lata sling, to support the corners of
the lip and nostril and balance the facial features. 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. Surgery in children involves the use of cross facial nerve grafts to cut into selected areas of the facial nerve on the normal side of the face. These grafts are then used as a conduit for the growth of the “electrical wiring” to the paralyzed side of the face. In cases where facial paralysis has been long-standing, a second procedure is used to transfer muscle from the inner thigh to replace the paralyzed smile muscles.
In teens or adults with facial paralysis following Bell’s Palsy or Acoustic Neuroma, a
variety of static and dynamic techniques can be used to restore a more normal appearance to the face. Fascia lata grafts (“tendons” from the thigh) 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.
Regional muscles transferred from the adjacent scalp or neck are used to “reactivate” the facial expressions and return smiles to a more “‘natural state”.
Usually, you will be able to resume normal activities anywhere from two to three weeks after your surgery. With most procedures, early movement is anticipated at 4-6 weeks post-surgery. After recovery, you will be referred to a physical therapist in your area to initiate facial retraining, biofeedback and home exercises to facilitate return of your facial expressions. Often, a secondary outpatient refinement surgery is necessary at 3-4 months to make minor cosmetic adjustments.
Facial reanimation is usually covered all or in part by insurance because it is medically necessary surgery. After your initial visit, Dr. Rose will write a comprehensive letter to your insurance carrier describing the surgical plan and request pre-determination for the reconstructive services. Although we don’t belong to any managed care plans, our efficient office staff will strategize with you to achieve maximum benefits from your insurance carrier. We are your advocate!
Feel free to email us regarding any scheduling or general questions!