Facial nerve surgery
Various surgeries may be offered to people with facial palsy. These include procedures to help a person smile, improve the closure of an eye, and restore symmetry to the face at rest. In addition to the different surgeries, there are various treatments and therapies which can be helpful to people living with facial paralysis.
As with any surgical procedure, there are risks associated with facial surgery which should be explained fully by your health care provider, before you agree to a procedure.
There are limits to what any surgery can achieve so it is important to have realistic expectations. Currently there are no surgical treatments that can restore your face to the way it was before your facial palsy, or to the way it should have been if you were born with a facial palsy. There are also many people living happy and fulfilled lives who have decided against having any surgery.
Surgery options may include:
- Facial nerve decompression – occasionally performed early on to relieve pressure on the nerve to allow it to work better.
- Oculoplastic surgeries – a set of procedures in the eye region designed to protect eye function, improve symptoms of dryness and tearing and also overall appearance.
- Smile surgeries – operations designed to restore symmetry at rest or even to create a smile movement on the affected side.
- Rejuvenating procedures – one of the consequences of having a facial paralysis is that the tissues of the face tend to droop more. Various procedures can help reverse that effect and improve symmetry. These include: brow-lift, face-lift, mid-face lift, fat grafting.
In facial palsy, the eyebrow may droop, the upper lid may be too high (retracted) due to un-opposed action of the muscle which opens the upper eyelid (levator muscle), and the lower lid may be droopy and sag downwards (exacerbated by the effect of gravity). The eyelids do not close over the eye which can make it susceptible to discomfort and visual loss. The aims of treatment are to improve the comfort of the eye and preserve vision. The secondary aims are to improve the cosmesis and reduce symptoms such as watering.
Upper eyelid surgery:
- Eyelid lift (blepharoplasty)
- Eyelid loading with gold/platinum weights
- Platinum chain
Lower eyelid surgery:
- Lateral canthopexy
- Medial canthoplasty
- Endoscopic brow lift
- Direct brow lift
Facial reanimation surgeries are sometimes simply referred to as ‘smile surgery’, but there are in fact several different ways this surgery may be performed. The type of surgical approach may differ depending on the patient’s age, the type and the duration of their facial paralysis, i.e. how long they have had the facial palsy.
Facial reanimation or smile surgeries may be divided into two broad groups; those aiming at achieving improved symmetry at rest, but without movement (static procedures) and those procedures designed to create active movement as well (dynamic procedures).
The static smile surgeries include:
- Fascia lata sling (static sling)
- Static sling (other material)
- A dynamic lower lip tightening
- Eyelid procedures
The dynamic smile surgeries include:
- Anterior belly of digastric transfer
- Temporalis Muscle techniques
- Labbé myoplasty
- Other transfers (McLaughlin or Rubin, for example)
- Nerve repairs, transfers and grafting
- Cross facial nerve graft
- Hypoglossal-facial anastomosis
- Nerve to Masseter Muscle
- Free muscle flaps – Pectoralis Minor, Gracilis, Serratus Anterior