Facial Reanimation Surgical Procedures
Facial reanimation procedures are extremely intricate surgeries given the proximity of the facial nerve to other important structures, including the eighth cranial nerve which is responsible for hearing and balance. The ENT facial plastic surgeons at University Hospitals have the advanced training, skills and experience to perform these delicate procedures and provide their patients with the best possible cosmetic and functional outcomes.
Your health is important. Get expert care.
If your facial paralysis symptoms persist and do not improve with conservative treatments, call 216-844-3223to schedule an in-person consultation with a UH ENT facial plastic surgeon.
Virtual appointments are also available.
A Comprehensive Evaluation Is the First Step
Our surgeons will first perform an in-depth consultation to assess the patient’s facial nerve and muscle function, facial symmetry and any related speech, breathing or eating problems. They will also take a medical history and make note of which treatments and therapies have already been tried. They will then offer recommendations for surgical procedures that may relieve the patient’s symptoms, restore function and/or improve appearance. All procedures are performed through incisions that are aesthetically hidden for an optimal cosmetic outcome.
Surgical Treatment Options
Surgical options for the treatment of facial paralysis will be determined by how long the patient has been experiencing symptoms, the severity of the paralysis and the specific facial organs affected. Based on the results of the comprehensive evaluation, your surgeon may recommend one or more surgical procedures.
Eyelid Closure
Facial paralysis that prevents the eye(s) from fully closing can put the eye at risk for excessive dryness and loss of sensation, which can ultimately lead to eye ulceration and infection. If nonsurgical treatments such as eye lubrication and external eyelid weights are not sufficient, we offer a surgical procedure to correct eyelid closure. During the surgery, we place a thin platinum weight under the upper eyelid skin to help achieve better descent of the eyelid and full eyelid closure. The weight can be removed at any point if it is determined it is no longer required.
Facial Nerve Decompression
When the facial nerve is compressed by surrounding bone or muscle due to injury or disease, the associated facial muscles can become numb or paralyzed. Decompression surgery removes whatever is pressing on the nerve to relieve the pressure, improve blood circulation and restore feeling and function. Nerve decompression surgery is most effective for acute episodes of facial paralysis in which symptoms have been present for less than three weeks.
Facial Nerve Repair and Grafting
If the facial nerve itself is diseased or damaged, a direct nerve repair may be a good surgical option. In this procedure, the affected segment of the nerve is removed and the two nerve ends reconnected. If there is not a sufficient length of nerve to reconnect the ends, a piece of nerve taken from elsewhere in the body may be used to “bridge” the gap created once the injured portion is removed. This is called a nerve graft.
Facial Nerve Transfer and Reinnervation
If the original source of input into the facial nerve and muscles is limited or completely unavailable and we know the facial nerve will not regenerate, a nerve transfer procedure may be recommended. In these procedures, a nearby, healthy nerve or nerve branch is cut and its end is sutured to the non-functioning nerve. Over time, the healthy nerve will grow into the damaged one and restore movement to the associated muscle(s). There are three main nerve transfer procedures that may be performed alone or in combination with one another. These include:
Cross Face
Nerve Graft
Masseter Nerve
Transfer
Hypoglossal Nerve Transfer
Muscle Transfer Procedures
Long-term facial paralysis (more than two years) often leads to atrophy of the facial muscles which have lost function and cannot be reanimated. In these cases, taking functional muscles and nerves from elsewhere in the body and “transplanting” them in the face can be an effective reanimation technique. Muscle transfers may require more than one procedure and several brief hospital stays. Procedures may include:
Temporalis Tendon Transfer
Gracilis Muscle
Transfer
Selective Muscle Myectomy
Muscle myectomy is a surgery involving removal of a muscle that is moving unfavorably, commonly seen in patients who experience a limited recovery after facial paralysis. The most common reason for this procedure is to treat muscles around the mouth or neck that are pulling the corner of the lip down, leading to discomfort or an abnormal smile. A myectomy can remedy this by removing a portion of the dysfunctional muscle. Often, we would first inject Botox® into these muscles to temporarily weaken them and investigate if a myectomy would be effective as a long-term option.
Selective Neurectomy
Abnormal, uncoordinated muscle movements of the face (synkinesis) is often due to abnormal nerve activity in patients who experience a limited recovery after facial palsy. Neurectomy is a procedure during which we excise the specific nerves that are no longer communicating properly with the facial muscles The malfunctioning nerves are identified and either cut out or rerouted to improve facial movement. Similar to myectomy, we will often try Botox® injections first to ensure a neurectomy is necessary for an optimal outcome.
Your health is important. Get expert care.
If your facial paralysis symptoms persist and do not improve with conservative treatments, call 216-844-3223 to schedule an in-person consultation with a UH ENT facial plastic surgeon.
Virtual appointments are also available.