Facial Palsy
Facial Palsy
The expressions of the human face are extraordinary. They convey subtle emotions, laughter, joy and sorrow. They result from the dance of more than a dozen muscles that are innervated by the 5 branches of the facial nerve. This is a cranial nerve that exits the skull through the ear canal and passes through the parotid gland in front of the ear. The muscles are unusual in that they attach to the skin (rather than bone) and allow for the huge variety of movements we all intuitively learn to use as infants.
Facial palsy, a loss of function of those muscles, can be present at birth (congenital) or occur later in life. The commonest cause is a Bell’s palsy, which is thought to be in response to a viral infection, but there are a myriad of other possible causes. It can occur as a result of trauma or surgery, typically after excision of an acoustic neuroma of the inner ear. We classify facial palsy according to how many of the muscles are affected (complete or partial), and whether one or both sides of the face are affected (uni- or bilateral).
In many cases of acquired palsy the recovery of the nerve can restore a significant degree of facial movement. This recovery is difficult to predict, but we know that the timing of even a small amount of movement after Bell’s can indicate how much recovery is likely. This can help in deciding how long to monitor the improvement of symptoms before intervening. The native muscles are still far better at creating expression than any reconstructive options. Where the nerve has been divided, surgically or in trauma, or is not present at birth, recovery will not occur and surgical intervention is required.
dynamic or static reconstruction
It is devastating to lose your smile. Whilst every single patient who is affected by facial paralysis wants to recover their confidence and expression, the options for reconstruction are varied and the choice of reanimation needs to be carefully tailored to each case. Mr Woollard works closely with a multi-disciplinary team including a clinical psychologist, nurses, physiotherapists and play specialists to ensure that any patient receives a holistic treatment plan.
In the very young the paralysis may only be apparent when they are very animated and one side of the face does not move. The soft tissues of the face are still youthful and elastic, at rest the difference between the two sides can be difficult to identify. In the older face, when some of that elasticity has gone and the effects of gravity have started to show, the loss of symmetry at rest becomes more problematic: patients complain of drooling, obscured speech and people staring at them in public.
The dynamic procedures to restore emotive smile (and blink) rely on nerve regeneration. This is a process that deteriorates with age and becomes less able to provide sufficient power to drive the transferred muscle. Results have shown that after the age of approximately 55-60 it is difficult to justify the benefits of a muscle transfer and in this age group we focus on procedures that provide static stability. This can deliver a robust, stable face that restores some confidence.