Even though 50% of paralysis cases are due to idiopathic causes (Bell’s palsy) and idiopathic facial paralysis has a good prognosis of spontaneous recovery, many things exist that can injure the facial nerve, like infection, trauma and tumours. There the prognosis is not so benign.
There is a great deal of unawareness, among both the general public and healthcare professionals, about the treatment possibilities available to patients who have irreversible facial paralysis.
Surgery offers a large number of techniques for repairing the injured nerve, improving the face’s appearance in repose or during facial mimicry and helping protect the eye to avoid devastating complications for the eyesight. The surgical options may be aimed at improving how the face looks in repose, through static techniques for suspending the paralysed tissues. Other procedures strive for dynamic facial reanimation, which means they attempt to restore facial mobility by transplanting muscles from elsewhere in the body to the face.
The techniques that can be used include:
- Facial nerve repair, by microsuturing nerves, with or without interposition nerve grafts.
- Anastomosis of nerves to adjacent nerves (XII, XI, masseteric nerve, etc.).
- Cross-facial nerve grafts.
- Microvascular muscle flaps.
- Muscle transposition.
- Oculoplastic surgery.
- Static facial suspension techniques.
At the Maxillofacial Surgery Department of MD Anderson Madrid, we specialise in facial nerve surgery, and we offer a wide variety of therapy alternatives to help improve life after facial paralysis, such as:
- Local flap to correct paralytic ectropion (drooping lower eyelid).
- Weighting of the upper eyelid with gold or platinum in the treatment of lagophthalmos (inability to close the eye).
- Gracilis muscle transplant.
Dr. Antonio Fernández García and Dr. Néstor Montesdeoca, Oral and Maxillofacial Surgery Department, MD Anderson Madrid.