Facial paralysis can occur as a result of many different situations including:
- Tumors in the ear canal
- Surgery of the ear or face
- Idiopathic (Bell’s palsy)
- Facial trauma
Once it is determined that there is a low likelihood of the nerve function returning or the paralysis is deemed chronic (>2 years) facial reanimation may be considered. Treatment of facial paralysis involves many different procedures with the main goals being to restore moisture to the eye with good eye closure, restore function of the mouth, and create symmetry in the face.
Restoring Eye Closure
Initially, the attention much be given to care of the eye. A regimen of eye drops, ointment and taping or a moisture chamber is recommended. If eye closure does not return, consideration is given to placing a weight in the upper eyelid to help it close. As time passes it may also be required to perform a lower lid tightening procedure to address any laxity. A brow lift on the affected side is often also done for symmetry.
Recreating a Smile
In facial paralysis, one side of the mouth does not move with smiling or eating. This can be the biggest problem in going about your day to day life. Patients are often self-conscious as this is the most noticeable part of their condition.
There are several procedures to treat the mouth. The simplest is to use tissue as a sling to permanently raise the side of the mouth. The mouth does not move, but you are able to eat and drink fairly normally.
A better option is to restore the function of the mouth with motion. Dr. Saxon achieves this by making a small incision in the skin crease between the nose and mouth (nasolabial fold) this gives access to the insertion of the temporalis muscle on the jaw bone. The end of the muscle is then rerouted to the edge of the mouth also known as a temporalis tendon transfer. Once healing is complete, patients are able to smile by clenching their teeth. This is learned in part by physical therapy which is required after this procedure.
As time passes, the paralyzed muscles atrophy causing that side of the face to become flatter. There are several ways to correct this. One is with hyaluronic acid filler which will have to be repeated every 6 months or a year but is very predictable. There is also another filler called Sculptra which may take several treatments but will eventually be permanent. The last option is to use your own fat to inject into the face. Fat injection may also take several treatments but is also permanent. Patients who only want their body’s own tissue like this option.
Some patients with facial paralysis may experience spasm of the muscles of the face. Also, one part of the face may twitch when they’re trying to move another part. An example is mouth twitching when one is trying to blink. The main way to correct this is with Botox. Small amounts of botox in specific areas will help to reduce the contractions. This treatment has to be repeated approximately every 3-4 months.
A stepwise approach
There is often no black and white answer to the treatment of facial paralysis. Each procedure is tailored to the patient’s needs, physical deformity, and lifestyle. Patients will develop a relationship with Dr. Saxon over time to plan procedures as necessary.