Treatment Options at Ohio State for Partial or Complete Facial Paralysis

Author: Ohio State Wexner Medical Center

I see a lot of patients for facial paralysis, which can be sequelae from stroke, parotid cancers, or parotid tumors or parotid surgery, as well as tumors of the brain and a skull base. Facial paralysis is a devastating a condition with profound aesthetic, functional and psychosocial implications. I um perform surgery a to address all of the issues related to facial paralysis.

This may include non-surgical treatments such as Botox for synkinesis to a facial reanimation surgery such as nerve transfer procedures, nerve crafting procedures as well as muscle transfer procedures, such as the temporalis tendon transfer and the gracilis muscle flap. When patients develop facial paralysis as a result of their disease or surgery, there are various ways that they can recover. They can recover completely and have normal function, or incompletely and developed incomplete movement or what we call synkinesis or abnormal facial movements. One of the ways to treat incomplete facial paralysis in patients who develop abnormal facial movements is using botulinum toxin or Botox to relax some of the muscles that contributed to contribute to abnormal facial movements. I find that it is also very important to undergo physical therapy called facial neuromuscular retraining therapy in order to holistically treat the abnormal movements that may occur with incomplete facial paralysis.

Chemodenervation with Botox lasts approximately three to four months so most of my patients come and see me every at three to four times a year to obtain this treatment. Patients who have facial paralysis, if they experience incomplete recovery within one year or less I recommend that they undergo a procedure called a nerve transfer procedure. Sometimes this is performed at the time of a parotid surgery or another type of surgery where nerve um transection or cutting of the nerve is anticipated. In other cases, where a duration of paralysis less than one year, I recommend using another nerve to try to move the muscles of the face. The most common nerves for this are at the masseteric nerve, which is a chewing nerve or the hypoglossal nerve which moves your tongue.

Sometimes we also use a nerve from the other side of the face, the facial nerve to a do a nerve transfer as well. When we do nerve transfers, we want to take nerves that would not contribute would not create a a functional deficit where we take it from. For example, when we take the chewing nerve we know that this masseter nerve and the masseter muscle is one of many chewing muscles and therefore a taking a the masseter nerve to reinnervate the face creates little in terms of functional morbidity for the for chewing.

Treatment Options at Ohio State for Partial or Complete Facial Paralysis

For patients who have been paralyzed for more than one year or two years, we recommend doing a muscle transfer procedure. The reason this is recommended is because after one or two years the muscles in the face that do not have innervations start to atrophy away. New muscle must be brought in in order to create the function of a smile. There's two main options to do this, one is called a temporalis tendon transfer and the second is a gracilis free flap.

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