Facial paralysis can result from nerve damage due to congenital (present at birth) conditions, trauma or disease, such as stroke, brain tumor or Bell’s palsy.
The problem can affect one or both sides of the face, with noticeable drooping of the features and problems with speaking, blinking, swallowing saliva, eating or communicating through natural facial expressions.
Treatment for Facial Paralysis
Paralysis of the face may be temporary or permanent. The facial plastic surgery team determines the best treatment based on how long the paralysis has been present, the cause and whether it is a complete paralysis, or an incomplete (or partial) paralysis.
Facial Paralysis Surgery
Facial paralysis surgery is also called facial reanimation surgery. A facial plastic surgeon can use all or parts of muscles, nerves or both from other parts of the body to restore motion to the lower half of the face. Because of the importance of facial mobility in creating recognizable facial expressions and communicating with others, addressing paralysis of the face is more than a cosmetic concern, especially in children.
Nerve Transfers
When a facial nerve is injured, there is a period of time during which it may be possible to restore lost nerve function to (reinnervate) the muscles of the face by transferring another nerve to that area. For example, a branch of the nerve responsible for chewing can be released and attached to one or more branches of the facial nerve. If this is done soon enough after an injury, it is usually successful.
If nerve function is lost, as time goes on the muscles of the face weaken and degrade. When a year or more has passed, the opportunity to reinnervate the facial muscles may be lost. Even if this happens, there are options to restore movement and expression to the face.
Temporalis Tendon Transfer (T3)
The temporalis muscle and tendon are located in the face. The muscle’s purpose is to help with chewing. The plastic surgeon can move these structures to another position, a relatively simple operation that takes less than an hour.
One drawback to this procedure is that the person must clench the teeth to smile, which takes practice. With work, over time, most patients can achieve an almost effortless smile. Although there is a theoretical risk of trouble chewing following this surgery, that risk is minimal.
Gracilis Muscle Transplant (Free Flap)
The gracilis muscle is located in the inner thigh. A small portion of this muscle, called a flap, along with its corresponding nerve and blood supply (artery and vein), can replace the facial muscles that allow the person to smile.
Using highly specialized microsurgical techniques, the surgeon transplants the gracilis muscle’s artery and vein and attaches them to a corresponding artery and vein in the head and neck region. This connection is critical for the muscle to survive in its new environment in the face.