CONGENITAL FACIAL PARALYSIS
Congenital facial palsy (CFP) is paralysis/weakness of face due to weak or absent nerve which supplies the muscles of facial animation. The weakness or paralysis is present at birth or shortly thereafter. Clinical presentation/s may include;
Drooping of the face on one side
Asymmetrical smile
Inability to blink
Drooling of saliva
Feeding and speech difficulties
Taste alterations
There are some syndromes whose presentation include facial palsy such as Moebius, Poland’s, and Goldenhaar’s syndrome.
Moebius syndrome is a bilateral problem and the child presents with a mask like face with no facial expressions.
Depending on the cause and severity of a child’s facial paralysis
Non-surgical therapies (physical therapy and treatment with botulinum, fillers or steroid medication) may be sufficient to resolve the problem.
Surgery( Facial reanimation surgeries which involve nerve graft or anastomosis, muscle transposition, Static surgeries, ie. plastic surgery to improve symmetry at rest but no improvement in movement)
The best outcome expected in these cases is facial symmetry at rest, near symmetry with voluntary movement, and spontaneous emotive movement.
FAQ
1. How much time does it take for facial reanimation surgeries?
Depending on the procedure and surgeon’s preference, procedures may take from 2 hours to 8 hours if free muscle and anastomosis are being done.
2. How many days one needs to be hospitalized for facial palsy surgery?
There are few office procedures like botox. Reanimation surgeries patients need to stay in hospital from 3 days to 1 week.
3. How much time is required for recovery?
Wounds are usually healed in 2 weeks. Functional recovery depends on procedures done like it takes usually 9 to 18 months for function to
ACQUIRED FACIAL PARALYSIS Acquired facial paralysis
Weakness of facial muscles which presents in latr year of life not due to any birth defect is called acquired facial palsy/paralysis. It can be due to infections, tumors, trauma, stroke and other inflammatory conditions
Infections like Herpes Zoster
Tumors like tumors of ear, brain or parotid gland
Trauma like facial trauma leading to fractures of skull and facial bones, soft tissue trauma in the course of nerve or trauma at birth
Brain Stroke
Clinical presentation/s may include;
Drooping of the face on one side
Asymmetrical smile
Inability to blink
Drooling of saliva
Feeding and speech difficulties
Taste alterations
Non-surgical treatment options include botulinum toxin therapy fillers or steroid medication, antiviral medications may be effective to resolve the problem.
Surgical techniques of dynamic facial reanimation commonly performed are loco-regional muscles transfers and free muscle transfer and nerve graft
Expected results need to be explained to patients in detail and patient anticipation and cooperation has a vital role in results. Patient will need an inpatient stay. Physical therapists teach the patient how to use/activate the face.
1. What are chances of success in acquired deformities
It depends on the causes and severity of the problem. Generally a fair to good result is expected from these surgeries.
2. How much stay in hospital is required
Botox and fillers are done as office procedures. Facial reanimation surgeries require 2 to 8 hours depending on procedure.
BELL’S PALSY
Bell’s palsy is a condition that causes a temporary weakness or paralysis of the muscles in the face due to viral or bacterial infections like herpes simplex, HIV, Sarcoidosis, EBV.
It can occur when the nerve that controls facial muscles becomes inflamed, swollen, or compressed. The condition causes one side of your face to droop or become stiff.
Clinical presentation/s may include;
Jaw pain
Pain in or behind the ear on the paralyzed side of the face
Headache
Drooping of the face on one side
Asymmetrical smile
Inability to blink
Drooling of saliva
Feeding and speech difficulties
Taste alterations
The initial treatment often involves high-dose steroids (prednisone) and antiviral medications and physical therapy. Recovery time may vary from a few weeks to six months depending on severity of nerve damage. If the patient does not recover completely from Bell’s palsy symptoms, surgery may be required. Around 85 percent of Bell’s palsy patients will recover from Bell’s palsy without any long term health issues. 10 percent of Bell’s palsy patients may have partial facial paralysis. The remaining 5 percent of Bell’s palsy patients will require comprehensive Bell’s palsy treatment.
FAQ
1. What are the causes of Bell’s palsy?
Bell’s palsy may be caused by viral or bacterial infections, or may present with no known cause.
2. How much time is required for recovery?
It may take few week to 6 month for recovery with medical treatment and physiotherapy
3. Is surgery required to treat Bell’s palsy?
Surgery is not always required but in few patients recovery is not complete and surgery may be required to correct these deformities
STATIC AND DYNAMIC FACIAL PARALYSIS RECONSTRUCTION
Static reconstructions provide support and improve balance, but do not move the facial muscles.
These include:
- Tarsorrhaphy (involves partially sewing the eyelids together to narrow the eye opening to help protect the eye)
- Medial canthoplasty (Medial canthoplasty means reducing the eyelid length and palpebral fissure (aperture between the eyelids) by removing some of the eyelid in the corner next to the nose.)
- Insertion of gold weights or springs (Inserted into the upper eyelid to help eye closure)
- Brow lifts (procedure to raise the brows which improves the appearance of the forehead, the brow and the area around the eyes by raising the soft tissue and skin of the forehead and brow. It can be done by botox, endoscopically and by excising forehead skin)
- Static slings (Fascia or tendon grafts can be used to elevate the corner of the mouth and nasal ala.)
- Lower lip wedge resection(can be done to improve oral competence )
DYNAMIC RECONSTRUCTION
- Primary nerve repair
In early injury due to trauma both proximal and distal ends of nerve are repaired primarily. A tension-free closure under microscopic magnification is necessary to assure a high rate of success.
- Nerve grafting involves moving nerves from different parts of the body to the face. Some examples involve moving the hypoglossal nerve in the tongue, facial grafting and cross-facial grafting to the affected side.
- Local muscles transposition
The surgeon removes one or more tendons or muscles and relocates them to areas of the face where they can restore more natural movement. Examples are temporalis muscle transfer
- Free muscle transfer
Gracilis, serratus anterior and latissimus dorsi flaps can be used for this purpose. gracilis muscle is most commonly used. In single stage procedure donor muscle nerves are coapted with cranial nerves like nerve to massage or hypoglossal nerve. In a two-stage operation Gracilis or any neuromuscular flap transferred to face powered by the contralateral facial nerve.
In the first stage of the operation, the sural nerve is harvested from the leg and coapted to the normal contralateral facial nerve. Typically a branch that innervates the zygomaticus muscle is utilized for re-innervation of the transferred muscle.
After a few months, the second stage of the operation is done, Gracilis muscle from the inner thigh along with its own nerve and vascular supply is harvested. Under microscope, gracilis’s nerve is coapted to previous sural nerve stump and vessels are anastomosed to facial vessels.
Written by : Dr. Fahmina
Copyrights: Pakistan association of Plastic Surgeons