Facial ParalysisLet us help
Simply put…facial paralysis is the inability to move the face. However, this simplifies the true importance of what the face really does. As human beings, we rely on our faces to communicate emotions, establish bonds with others, and protect important functions such as eyesight and speech. The true importance of facial expression is often overlooked until it is gone.
There is no single cause of facial paralysis, but it involves damage to the facial nerve, which innervates all of the muscles of facial expression. Sources of that damage can include viral infection (Bell’s palsy), trauma, tumor, certain medications, autoimmune disorders, or other causes. Sometimes, it is possible to regain that function over time. However, nerves regenerate at a very slow rate. Recovery may take weeks to months or years to occur. However, sometimes the damage is irreversible, and the result is permanent facial paralysis. It may affect one or both sides of the face. It may occur asymmetrically. There may be residual weakness or incomplete paralysis. The overall picture can be quite varied.
Facial paralysis can be broken down into areas of the face that are most noticeably affected… the forehead, eyes, and smile. No two patients are alike in their appearance and degree of facial paralysis. To understand the reconstructive options for each area, click on the appropriate links for details. Dr. Panossian’s expertise in reconstruction of facial paralysis is quite extensive. He engages in research aimed at understanding the basis for facial paralysis and strategizing new techniques to improve surgical outcomes. If you have been affected by facial paralysis, contact Dr. Panossian to begin your path to recovery.
Your smile is one of the most unique characteristics about your face. Losing the ability to smile can have profound effects on the ability to socially interact with others, communicate, and develop one’s self image.
Numerous options are available for patients requiring reconstruction. Generally, these options could be categorized as “static” or “dynamic” in nature. Static reconstructions involve resuspending the corner of the mouth in a natural position to counteract the droop of the paralyzed face. This can be done in a number of ways using several natural and artificial options. Dynamic reconstructions involve the use of techniques to re-establish muscle control of the paralyzed face. This typically involves the transfer of a muscle from another part of the body to the face where it is reconnected to a new blood supply and plugged into a functioning nerve. Over time, the new muscle gains the ability to move and re-activate the lost smile.
Dr. Panossian has developed a new take on an old technique (ie, the Labbe technique) designed to reanimate the smile using a muscle for biting. This muscle, called the temporalis, is one of four muscles used in biting, and it is located on the side of the head. When biting, the muscle can be felt to tense up. What makes this surgery ideal is that it utilizes a nearby muscle that is already functioning to achieve a smile. Specifically, the insertion of the muscle on the lower jaw is changed so that the muscle begins to pull on the corner of the mouth. The muscle is functional for smiling from as early as several days after surgery. Over time, the muscle begins to move spontaneously when trying to smile, even though it was originally used for biting. There are numerous advantages of this technique: it can be done in an outpatient setting for most patients, scars are minimal, bulk in the cheek is significantly minimized, and time to achieving results is improved.
Other methods are also available to dynamically reconstruct, not only the smile, but possibly all of the paralyzed facial muscles. In those patients presenting early on in their facial paralysis (within the first 9 to 12 months), nerve transfers and nerve grafting may be options for treatment. This entails “re-wiring” the affected facial nerve so that it receives innervation from another nerve in the face. This may be achieved via a nerve graft from the opposite (unaffected) side of the face using a branch of the functioning facial nerve. Or, a different unaffected nerve on the same side of the face may be transferred and plugged in. This first type of surgery is called a “cross-face nerve graft,” whereas the second type is a “nerve transfer.” The nerve graft is obtained from the leg through small incisions and does not result in any functional loss in the leg. The nerve transfer will utilize one of the branches of the fifth cranial nerve used for biting in most cases. Once again, there is usually no functional deficit where the nerve originated.
Both static and dynamic reconstructions are complex and have pros and cons as with all surgical options. Making the decision to pursue one line of treatment over another is difficult. It involves the desires of the patient, the degree of facial paralysis present, and the patient’s own physiology. Dr Panossian is one of only a handful of experts in the world with training and skill in restoring paralyzed faces with the full complement of options, especially with the intricate task of repairing one’s smile. Call Dr. Panossian today to discuss your options.
Dr. Panossian is the Founder of the Facial Paralysis Center at Children’s Hospital Los Angeles and has taken his multidisciplinary approach to his private practice. He leads a team of specialists dedicated to the comprehensive treatment of children and adults with facial paralysis.
Paralysis of the eyes and eyelids can result in a number of problems. The most serious problem is the inability to close the eye, which can remain open while sleeping. Persistent problems with eye closure may lead to drying of the cornea. In turn, this may result in permanent scarring and eventual blindness. This is the most compelling reason to treat facial paralysis.
Other problems include the appearance of the droopy lower eyelid. Initially, the droop may be subtle, but with time, the lower eyelid will fall further. This causes a noticeable deformity and one of the stigmata of facial paralysis. The upper eyelid may also have trouble doing its part to close the eye and can worsen the problem of the “wide eyed” look. Lastly, the dynamic effect of blinking can be affected. This is typically one of the most difficult functions to restore.
Several solutions exist for the variety of problems that can affect the eye in facial paralysis. The decision to pursue surgery is made in conjunction with an ophthalmologist’s evaluation. If signs of corneal scarring (ie, keratopathy) are present despite aggressive lubrication regimens, then the decision to undergo surgery is made urgently. Alternatively, if eyelid drooping (ie, lagophthalmos) is causing a severe cosmetic deformity, then one can also proceed with surgical correction.
A number of surgical techniques are available to correct eyelid paralysis depending upon severity. These include placement of an upper eyelid weight, lower eyelid tendon sling, or tarsorrhaphy (suturing outer part of upper and lower eyelids together), among others.
Synkinesis is the involuntary movement of facial muscles that can occur after recovery of the facial nerve. This happens most often in the setting of Bell’s palsy and can be quite disconcerting for patients. It is the result of miswiring of the downstream branches of the facial nerve during the process of nerve regeneration. In the setting of facial paralysis, eyelid twitching may be triggered by voluntary activation of other facial muscles, such as smiling or moving the mouth. Treatment to correct this problem can include surgical denervation of the interconnections between the involved muscles or with use of Botox.
Whether mild or severe, correction of eyelid problems is an important part of any treatment plan for facial paralysis. Dr. Panossian’s years of experience and specialized training in the correction of facial paralysis have assisted hundreds of patients seeking relief from their symptoms.
With paralysis of the forehead, the ability to raise the brow or create wrinkles is affected. People with forehead paralysis are not necessarily noticed right away. However, with animation and simple gestures, the lack of movement becomes obvious. Sometimes, forehead paralysis may result in gradual drooping over the upper eyelid. This can worsen over time and can even partially block vision.
As with other areas of the face, options are available for treatment of forehead paralysis. Although a paralyzed forehead may mimic a “permanent Botox” effect, many people don’t care for the look, especially when only one half of the forehead is affected. For those wishing to have a more uniform appearance, Botox injections to the unaffected side may produce the desired appearance. However, these injections may be required every 3 to 6 months to maintain the effect. Another option may be to permanently paralyze the normal side of the forehead with a surgical procedure. For patients experiencing problems with their vision due to a heavy, droopy forehead, a browlift will restore the height of the brow to a desirable level. Dr. Panossian has studied and refined these techniques over many years. Arrange a consultation today to discuss your options.