Breathing Procedures After Facial Paralysis

Why Does Facial Paralysis Cause Difficulty Breathing From My Nose?

Muscles of the face and nose help to pull outward on the nostrils and bridge of the nose which keeps your nasal airway from collapsing. When the facial nerve function is weakened or paralyzed, the muscles on the sides of the nose don’t work and can’t hold the nose open. The nose is unsupported and is more likely to collapse when breathing inward, causing an obstruction. This is called “dynamic wall insufficiency”, and can be corrected with nasal surgery that provides more support to the nasal walls. Furthermore, facial paralysis can cause drooping of the skin and soft tissue of the face and cheek, which presses on the sides of the of the nose making breathing more difficult.

Preparation For Facial Nerve Paralysis Surgery

You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.

Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.

What Kind Of Surgery Helps Correct The Nasal Obstruction Associated With Facial Nerve Paralysis?

Strength and support of the sides of the nose can be restored with adding structure to the inside of the nose.  The goals of this surgery is to restore airflow to the nose by increasing support to the nasal sidewall. This can be achieved through various techniques. Broadly speaking, this can be done by reinforcing the structure of the nose internally, or by improving the suspension of the soft tissue of the nose externally.

Internal Nose Reconstruction and Reinforcement

Through the use of grafts, such as cartilage taken from the ear, nasal septum, or rib, the internal structure of the nose may be strengthened which can help open the nose and prevent further collapse. The interior of the nose is approached through either a closed or open approach. The cartilage grafts are then placed in critical areas that prevent collapse and nasal obstruction. The internal and external valves are supported which provides for more airflow into the nose.

Suspension Techniques

Other options include suspension techniques that use special sutures to pull up on the sides of the nose, elevating the soft tissues of the cheek and nasal sidewall. This can be considered an “internal Breathe Right strip”, that provides support to the nasal sidewall improving obstruction.

Are There Any Other Surgical Options?

Other surgical options include reducing the amount of obstruction caused by contributing factors. This may include correcting a deviated septum, in a procedure known as a septoplasty. Turbinates are the large structures inside of your nose that can become obstructive and reduction can open the airways. A thorough consultation with an expert who is both an otolaryngologist and a facial plastic surgeon will help you decide what structural aspects of your nose can be improved to get you breathing better.

After Surgery and Recovery

Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting as this can alter the structure of the nose through straining. If you wear glasses, you may require some alterations as to not provide pressure on the nasal bones if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results.

You will see Dr. Mourad one week after surgery where he will remove all casting materials and splints.  Depending on the patient this swelling typically lasts for 2-3 weeks but can last up to two months in rare circumstances. To help reduce the swelling Dr. Mourad will re-apply tape to areas that will be there until your second post-operative visit. This pressure dressing reduces the amount of swelling. The second postoperative visit will involve removing all the tape. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.

Associated Risks

  • Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
  • Infection: In rare circumstances patients may develop an infection following nasal procedures. These are usually managed with intraoperative and postoperative antibiotics.
  • Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure, and minimize risk of bleeding. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
  • Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
  • Scarring and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
  • Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
  • Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
  • Persistent or Recurrent Nasal Airway Obstruction: Although the goal of surgery is to enhance breathing, sometimes patients may develop persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
  • Continued need for medical therapies: If you have breathing complaints related to medical causes (e.g. allergies), then you

Meet Dr. Moustafa Mourad, MD, FACS

Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck and entire facial area. Learn More »

Select Relevant Publications

Mourad M, Arnaoutakis D, Sawahney R, Ducic Y. Use of the Giant Bilobed Flap in Head and Neck Reconstruction. Facial Plastics Surgery. 2016 Jun;32(3):320-324. Link to Article.

Lee T, Wang L, Han R, Mourad M, and Ducic Y. Options in Repositioning the Asymmetric Brow from Paralysis and Trauma. Thieme Medical Publishers. 2017; 33(06): 627-638. Link to Article.

Mourad M, Vincent A, and Ducic Y. Safe Autologous Rib Harvest in Patients with Breast Implants. Presented at: 12th International Symposium of Facial Plastic Surgery. 2018 October 18; Dallas, TX, USA. Link to Article.

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