AT THE ACUTE STAGE
Decompression of the facial nerve can be accomplished by a delicate microsurgical procedure. This surgery can make a critical difference with some types of severe nerve damage, but not generally for Bell’s Palsy. For Bells Palsy it remains highly controversial, even when nerve degeneration is severe. There is not likely to be any benefit over prompt treatment by standard meds, and there are serious risks involved. The most common complications are hearing loss and damage to the facial nerve, which can be permanent. If this procedure is done for any reason, it should be done within 3 weeks of nerve damage. After this time statistics show no benefit for enduring the surgery and the potential risks.
FOR LONGTERM WEAKNESS AND RESIDUALS
There are reconstructive options for long-term weakness or paralysis. Some are “static” – purely cosmetic; some may help regain function. These procedures are more often performed when the nerve has been cut or severely compressed than after the “typical” short-term compression of viral and bacterial induced paralysis. While these techniques can offer improvement (better symmetry at rest or some improvement to the smile), they cannot fully restore natural movement or expressions.
Cosmetic surgeries such as brow-lifts, face-lifts, muscle shortening, removal of excess upper eyelid skin, muscle relaxing procedures and static slings are available to improve appearance, but they will not improve muscle function.
Nerve and muscle grafts or transpositions can offer functional improvement as well as improve appearance. These are complex procedures that should be considered carefully. Take care to insist that the surgeon fully explains the procedure, recovery, and risks. Risks include nerve damage that can leave the patient with worse paralysis than prior to surgery.
One type of nerve transposition involves connecting the hypoglossal nerve (controls the tongue) to the facial nerve. After surgery, the patient learns how to move the face by moving the tongue. Ideally, the motion becomes automatic in time. There is likely to be a loss of sensation at the tongue.
A muscle transposition can be performed using a muscle that isn’t controlled by the facial nerve. The temporalis or masseter muscle can be connected to the corner of the mouth. The intention is that the enervated muscle will increase motion in the muscles around the mouth.
In a combination muscle and nerve graft, two procedures are performed several months apart. Free muscle tissue is grafted from the leg to the face following a cross-facial nerve graft. The nerve graft becomes the nerve supply for the healthy, transplanted muscle.