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Facial Paralysis

What Is Facial Paralysis?

Facial paralysis refers to the inability to move one’s face, usually as a result of nerve damage. It may affect one or both sides of the face, resulting in facial drooping, watery eyes, incomplete eye closure, or sagging of the brow and cheek.

What Causes Facial Paralysis?

Facial paralysis is caused by damage to the nerves that allow for movement of the facial muscles. This damage can result from inflammation, tumors, infection, stroke, trauma, surgery, or underlying medical conditions and neurological disorders. In cases in which the exact mechanism of paralysis is unknown, the facial paralysis is referred to as a Bell’s Palsy.

Moustafa Mourad performing Facial Nerve Examination for Facial Paralysis

What Is Bell’s Palsy?

Bell’s palsy is facial paralysis or weakness in which the exact mechanism is not known. The diagnosis is made as a “diagnosis of exclusion”- meaning that all major causes of paralysis have been ruled out by history, physical exam, and diagnostic testing.

 

What is Bilateral Bell’s Palsy? Is it a separate condition then Bell’s Palsy?

Bilateral Bell’s Palsy is a term used to refer to weakness on both sides of the face. This, however, is not a true Bell’s Palsy. Bell’s Palsy exclusively refers to paralysis of the face without an indefinable caused as ruled out on all workup- referred to as an “idiopathic” palsy. Bilateral Palsy, however, more likely a result of an underlying neurological issue. The most common causes of facial paralysis on both sides of the face are infections (e.g. Lyme Disease, meningitis), autoimmune disorders (e.g. Sarcoidosis), hereditary disorders (e.g. Neurofibromatosis), or neurological disorders (e.g. Guillain-Barre Syndrome). If you suffer from paralysis of both sides of the face, it is important to rule out causative factors, before relying on the diagnosis of a Bell’s Palsy. Common workup of such disorders may include tissue biopsy, bloodwork, imaging (e.g. MRI) of the brain and spinal cord, and electrophysiological studies.

 

What Are The Symptoms Of Bell’s Palsy?

In addition to the weakness of the facial muscles, you may experience sensitivity to sound (called ‘hyperacusis’), taste disturbances, and watery eyes.

 

Is Nerve Damage In Bell’s Palsy Permanent?

The vast majority of Bell’s Palsy related paralysis is temporary and self-resolving within 3-6 weeks. Typically you should expect to see some resolution of facial movement within the first two weeks. More severe cases of facial paralysis, or in cases of complete paralysis, nerve function may not fully return. For cases in which paralysis is worsening or fails to resolve by 6 weeks, your specialist should order specific tests to rule out other causes of paralysis.

 

How Is Bell’s Palsy Diagnosed?

Your doctor may be able to diagnose Bell’s palsy simply based on your history and physical exam. A hearing test may be obtained to ensure that there is no involvement of vital ear structures. Other tests may be ordered if your physician suspects other underlying causes. Such tests may include blood work and imaging studies such as CT scans and MRI brain scans.

 

How Is Permanent Facial Paralysis Treated?

Depending on the exact cause and duration of paralysis different treatment options are available. The goals of treatment are to restore the smile, reduce vision impediments, and reduce disfigurement related to brow and cheek droop. There are two strategies used to restore and rehabilitate patients with facial paralysis- dynamic and static reanimation techniques. Dynamic techniques attempt to restore movement of the native facial muscles. Static reanimation techniques, however, attempt to restore form and appearance without restoring actual movement. It is important to seek consultation with a specialist who is trained in a broad range of reconstructive options to better serve your needs.

Dynamic Techniques

“Cable” Nerve Grafting

Facial paralysis that results from transection of the nerve, for example from trauma, or surgery, may be treated with cable grafting. This technique involves replacing a segment of damaged nerve with healthy nerves from the patient. Nerves can be obtained from the legs or neck, and used as grafts to connect the damaged and/or severed nerve endings.

“Cross Nerve” Grafting

Long segments of healthy donor nerves are used to connect the facial nerve from the unaffected side to the paralyzed side.

“Jump Nerve” Grafting

Jump grafting uses neighboring nerves that control the tongue or jaw to connect to the damaged facial nerve. By controlling the jaw and/or tongue, a person can learn to control their facial muscles.

Temporalis Muscle Transfer

This technique involves attachment of muscles that move the jaw to the facial muscles. By activating the jaw muscle, a patient may learn to voluntarily control their smile.

Gracilis Free Flap

Muscle, nerves, and arteries are obtained from the inner thigh, and used to reconstruct a patients smiling through attachment to the muscles of the face.

Static Techniques

Tissue Slings

A tissue sling may be used to suspend and elevate the paralyzed side of the face into a more favorable position. Tendon like tissue can be harvested from the thigh in order to serve as the sling. Other slings may involve use of synthetic material, or tendons harvested from other body sites.

Lid Tightening Procedures

Also known as a tarsorrhaphy, the lower eyelids can be placed in a more favorable position by tightening and repositioning the eye lid in a more favorable position.

Gold Weights

Small gold weights can be placed in a pocket in the upper eyelid in order to allow gravity to assist in closing the eyes.

Brow Lift

Facial Paralysis may cause the brow and forehead to droop. This descent can be so severe that it may compromise vision. Brow lifts involve elevating the brow and placing in a more favorable and natural position.

Rhinoplasty

Some patients may experience nasal congestion and airway obstruction due to collapse of the nasal structures on the affected side. Reconstruction of the nose to reinforce the collapse will allow for improved breathing.

Can Injectables Help Treat Facial Paralysis?

Sometimes injectables can help in achieving a symmetrical appearance of the face by targeting areas on the non-paralyzed areas of the face. Also, often times, patients with facial paralysis may have involuntary muscle spasms and ticks (e.g eye twitches) that can be controlled by an injectable.

 

Can Bell’s Palsy Recur?

Recurrence of Bell’s Palsy recurrence is exceedingly rare, but is possible. However, during the second episode of Bell’s Palsy, or a Palsy that occurs on the opposite side of the original episode, your physician should perform a more extensive workup to rule out any underlying causes of the recurrence. This would work up may include MRI and CT scans of the head and neck region, in addition to blood work. Sometimes a neurologist can perform muscle studies to help determine the cause of the paralysis.

Why Should You See Dr. Mourad For Your Facial Paralysis Needs?

Facial plastic and reconstructive surgeons are uniquely qualified to deliver a higher standard of care when it comes to reconstructing the face. It is important to find a surgeon that has experience in this area, as it requires highly technical and specialized skills. Dr. Mourad has extensive knowledge and training in the field of facial paralysis. He has been a leader paving the way describing new techniques. Dr. Mourad has written book chapters in textbooks that help in the training of present-day surgeons. He also has published extensively in peer-reviewed scientific journals and is well qualified to manage your facial reconstructive needs.

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

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.

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