Facial Paralysis

Facial Paralysis

Facial paralysis is socially devastating and functionally disabling. Facial expression is fundamentally important in face to face relations with others. Even partial paralysis may dramatically affect one's ability to interact in a satisfactory way. Sufferers gradually learn to cope but never fully adjust to their disability.

The tragedy is compounded by neglect. Firstly, these cases are often not offered surgical treatment due to a lack of appreciation of the many available surgical techniques. Secondly, facial ptosis increases with time, exaggerating the abnormal appearance and further impeding functions of the eye and mouth.

Irrespective of cause, salvage of function in cases of failed spontaneous recovery is dependent on timing of intervention. Successful treatment depends on early reinnervation (re-connecting a nerve supply) of the denervated (lacking nerve supply) facial muscle. After approximately 18 months of denervation the muscles undergo irreversible degeneration.

For effective salvage of the affected facial muscles, surgical intervention must occur within the first 12 months of facial nerve injury, as most reinnervation procedures take at least 6 months for the new nerve fibers to grow up to the muscle motor end-plates. Any delay beyond this period of time results in increased failure, due to irreversible muscle deterioration.

Once muscle degeneration has occurred then one must also import new muscle to mobilise the affected face. There are several good options; muscle selection depends on a number of factors which are discussed at consultation.

Finally there is a gamut of ancillary procedures which are used to address specific problems and to complement the main reconstruction. These help support the eyebrow, eyelids, nose and mouth. Overall appearance is concurrently improved by a face and neck lift.

The above reconstruction list is by no means exhaustive. There is a large range of options which have varying degrees of success and applicability. The key to good management is to make an individualised assessment of each case, both in terms of the paralysis and the patient in general. The former requires an accurate and comprehensive assessment of; cause, anatomical site and severity of paralysis. The second issue is equally as important and refers to the patient in terms of their wishes and suitability for the varying options. 

Other reconstructive surgery services we provide are