Facial Paralysis Repair

Facial paralysis is a debilitating condition that can inflict physical, social and psychological damage on patients and their families .At the facial paralysis restoration center, experts who specialize on the face and
the facial nerve combine  years of experience to treat individuals who have suffered injury to their facial nerve. Injury to the facial nerve is a common problem that can result from causes including Bell’s palsy, trauma and cancer. It may also be present at birth. Regardless of the cause, the movement
impairment that follows
may affect the eye, smile, nasal breathing and speech. The psychological toll can be
severe.  Dr. Sofola and colleagues at the facial paralysis restoration
center have years of experience treating facial paralysis patients with state of the
art techiqnues that they have helped refine.

 


TREATMENT OPTIONS FOR FACIAL PARALYSIS:

Neuromuscular Retraining

Neuromuscular reeducation (therapy): working with our specially trained physical therapist,
specific facial exercises one can relearn to cmove the face by suppressing unwanted movement while enhancing desired facial movement. This therapy is aided by video recording of desired facial movements such as a learned smile in a system known as self-modeling and social implementation

Targeted chemodenervation with injection

The botulinum toxin neuropeptide can be injected into specific muscle groups to help correct assymetry, muscle spasms, over contraction, synkinesis and is also used to facilitate the results of physical therapy

Static reanimation ( facelift, eyelid sling, midfacelift, Fascia lata slings)

The droopiness seen in the paralyzed face can be corrected with various procedures that even out the face and actually helps the face look younger. Brow lift procedures even out the droopy brow correcting the angry look. It also releaves strain of the eyelids. Facelift tighthens the paralyzed muscles and improves symmetry of the face. The droopy cheek is sometimes lifted ( midface lift) to help support and suspend the lower eyelid which improves eye closure.

 Platinum chain eyelid implants are flexible low profile implants that we place within the upper eyelid to aid in
eye closure. Because of their low profile nature, they are usually invisble where they are implanted
Eyelid suspension using free fascia slings or temporalis muscle slings helps suspend the retracted eyelids up which
aids in eye closure, tear distribution and thus reducing excessive tearing. Combined with spacer graft( tissue grafts placed within the lower eyelid), eyelid suspension techniques ( medial and lateral canthopxey) are key in protecting the eye from irritation, drying and ulceration.

Dynamic muscle and tendon transfer procedures ( temporalis tendon transfer, diagastric muscle  tendon transfer).

Tendon transfer procedures are common in hand surgery. We have used the same principles to design minimally invasive techniques from transposing the temporalis tendon toacheive immediate improvemnt
in smile.With this special and minimally invasive technique that we have helped advance, we are able to restore movement to the face and allow one to relearn the ability to smile. This is one of the most rewarding procedures we perform for facial paralysis because the result is almost immediate. Infact, with muscle
stimulators, we can record movement of the face minutes after the procedure is completed. The patient then learns to harness the power of the transfered muscle for smiling.

Nerve grafting ( facial nerve-hypoglossal nerve, cross facial  nerve grafting).

Whenever feasible, we try to reconnect the injured nerve either directly or by using nerve grafts harvested from the neck or leg. It usually takes 6 months to see results but the outcome continues to improve over several years.

Upgrading partially recovered facial
nerves

An important concept in facial paralysis treatment is the ability to improve nerve and muscle function in individuals who have incomplete facial nerve recovery or paralysis. The typical case is a patient who developes Bells palsy and recovers only partially. They have improved symmetry but an assymetric smile. The challenge is to improve their smile without disturbing the partial recovery they regained. We use a technique called “supercharging” whereby through nerve grafting more movement is restored to the smile muscles while preserving the recovery gained.

Free muscle transfer. ( gracillis muscle, vastus lateralis muscle, pectoralis muscle, serratus muscle transfer)

When nerve repair or muscle transfer is not feasible, we have the option of transferring muscle and nerve from other parts of the body to the face, connect the nerves to other nerves in the face to allow facial movement. The muscle being transfered does not leave a noticeable deficit. Common sites for transferring muscle includes the thigh, chest wall or back.

Synkinesis

One of the most bothersome sequelae of facial paralysis ( Bells palsy) is synkinesis. Synkinesis is the unwanted movement the accompanies a desired movement and it usually a sign of abberrent regrowth of the facial nerve. A common example is eye closure when one smiles or laughs.The explanation for why this happens to a recovering nerve following injury varies and includes; nerve fibers reaching the wrong target, changes in the sheath that covers a regenerating nerve and alteraltion of the facial nucleus at the level
of the brain stem.  Treatment options for facial synkinesis include nerve-muscle retraining aided by biofeedback techniques, selective disruption of nerve signals to the muscle group one desires to supress either by injections ( chemodenervation with botulinum neuropeptide ) , nerve division ( neurectomy) or selective removal of muscle (myectomy). The most distressing evidence of synkinesis usually involves the eye muscles and can be severe enough to obstruct ones vision. The involved eye looks smaller and cosmetically unappealing. We use a combination of the above methods to acjieve long-lasting improvement. See before and after photos of  surgical correction of synkinesis and blepharosm of the eye after Bells palsy.

Platysmoplasty

The platysma muscle is a broad thin muscle which is by development, an extension of the facial muscle into the neck. It is innervated by the facial nerve and acts to pull down the lower face. During recovery of an injured or repaired facial nerve, precious fibers of the regenerating nerve may end up in the platysma muscle diverting nerve fibers from desired targets in the upper face. In addition to this, cross talk between these platysma fibers and nerves to the midfacial and eye muscles may contribute to diminished lip evelation during smile and synkinesis. This  may also result in tightness in the face and can occasionally be painful. Dividing the offending platysma fibers ( platysmoplasty) has the potential of immediately relieving the facial tightness,
improving lip movement and minimizing synkinesis. Platysmoplasty for facial paralysis can be done under local anesthesia and is usually well tolerated.