Facial Nerve Repair

Dr. Douglas Henstrom of Utah Facial Plastics has a strong passion for complex nerve reconstruction and is known for his expertise in facial nerve repair worldwide. As a Mayo Clinic and Harvard trained board-certified facial plastic and reconstructive surgeon, his combined knowledge of facial aesthetics with underlying anatomy result in life-changing results for individuals with facial paralysis and Bell’s palsy.

 

What Is Facial Paralysis?

The facial nerve, also known at the seventh cranial nerve, splits into five branches that combined, allow for facial expression and function. Facial paralysis occurs when one or more branches of the facial nerve become impaired. This often results in the loss of certain facial expressions and/or abilities, such as chewing, swallowing and even speaking.

Facial paralysis is often caused by multiple factors and requires a specialized treatment plan for each individual patient. As Utah’s leader in facial nerve reconstruction, Dr. Henstrom provides a multidisciplinary treatment approach to prevent unwanted eye complications, restore facial movement, and improve the aesthetic appearance of the face.

 

What Are The Causes of Facial Paralysis?

Facial paralysis is caused by any condition that damages or inhibits the facial nerve in any way and can come on suddenly or happen gradually over a certain amount of months. Depending on the cause, symptoms can resolve rather quickly or may last for an extended period of time.

Because the facial nerve is so intricate, there are variety of causes. The most common conditions leading to facial paralysis include:

Bell’s palsy

Bell’s palsy is considered the most common cause of facial paralysis, according to the National Institue of Neurological Disorders and Stroke. This condition involves inflammation of the inner ear that results in pressure to the facial nerve, thus causing facial paralysis. The cause for Bell’s palsy is unknown but may be related to a viral infection (including herpes, influenza and respiratory tract infections) of the facial nerve. The majority of Bell’s palsy patients (approximately 70 percent) recover within six months though others may experience symptoms long-term in cases where the nerve damage is more severe.

Common symptoms of Bell’s palsy:

  • Partical or complete paralysis of one side of the face (1% of cases experience full facial paralysis)
  • Sensitivity to noise
  • Pain in the inner ear at the onset
  • Altered sense of taste
  • Difficulty eating
  • Difficulty speaking
  • Dry eye and watering on the side experiencing paralysis if unable to fully close

Stroke

A stroke is a serious condition that occurs when the blood supply to the brain is suddenly cut off. If the blood supply is restricted for long enough, brain cells can become permanently damaged.

There are a few ways facial paralysis can occur during a stroke. In the case of an ischaemic stroke, in which the the blood an oxygen supply to the brain has been reduced due of a blood clot, the lack of oxygen causes damage to the brain tissue and nerves. Seventy percent of people diagnosed with a stroke experience an ischaemic stroke. During a haemorrhagic stroke, a damaged or weakened artery may burst and bleed, which puts pressure on the nearby nerves, which can lead to facial paralysis.

Common symptoms of a stroke:

  • Facial paralysis
  • Weakness of an arm, leg or possiblyl both
  • Problems swallowing
  • Problems with balance and coordination
  • Problems with communication
  • Headache and confusion
  • Numbness in a part of the body
  • Possible loss of consciousness

Trauma

Common head and neck trauma occurrences include car and bike accidents, falls, physical violence or assault, as well as home and occupational accidents. The facial nerve travels through the temporal bone. Skull fracture to the temporal bone often causes facial paralysis when the nerve is damaged or impaired from the pressure of swelling afterwards.

Though rare, trauma can also occur during birth from the pressure of forceps or bone in the mother’s pelvis.

Common symptoms of trauma related nerve damage:

  • Dry eye and watering on the side experiencing paralysis if unable to fully close
  • Difficulty eating and drinking
  • Difficulty speaking
  • Inability to carry out facial movements and expressions

Tumors

Tumors can lead to facial paralysis with malignant tumors invading the facial nerve or with benign tumors close to and compressing the facial nerve. The most common tumors leading to facial paralysis include acoustic neuroma, facial neuroma and tumors in the parotid gland region.

Common symptoms of tumor related nerve damage:

  • Progressive or recurrent facial weakness
  • Hearing loss
  • Neck mass

Other Causes

Iatrogenic injury, which occurs during surgical procedures of the face and neck in which the facial nerve is compromised.

Guillain Barre Syndrome, an autoimmune disorder in which the body’s immune system attacks part of the peripheral nervous system.

Lyme Disease is a bacterial infection transmitted to humans via infected ticks and can lead to facial paralysis.

Ramsay Hunt Syndrome is a virus of the facial nerve and a more severe form of facial paralysis.

 

How Are Facial Nerve Disorders Diagnosed?

An extensive evaluation with Dr. Douglas Henstrom of Utah Facial Plastics is recommended initially to determine cause of facial nerve damage if previous diagnosis has not been made. Based on symptoms, he may recommend one or more of the following tests:

Hearing Test

A hearing test can help determine whether or not the nerve disorder has involved the hearing mechanism.

Tear Test

Testing the eye’s ability to tear is helpful in determining the location of facial nerve damage.

X-Rays

Scnas can help diagnosis infection, tumor or bone fractures, such as a CT scan or MRI.

Balance Test

Testing the balance system with an ENG (electronystagmography) can help determine location of nerve disorder.

Electrical Tests

Three electrical include a nerve excitability test (to determine extent of nerve fiber damage), electroneurography (measures muscle response to electrical stimulation) and electromyography (measures responses to determine if nerve and muscles are recovering).

 

What Treatments Are Available for Facial Nerve Repair?

As a double board-certified facial reconstructive surgeon and facial nerve specialist, Dr. Henstrom sees patients from all over the country for surgical and non-surgical treatment of facial paralysis. Dr. Henstrom is incredibly thorough during the consultation process and takes in to account both the aesthetic and functional components when determine the best course of action for treatment. There are a variety of non-surgical and surgical approaches Dr. Henstrom takes to provide a symmetrical and functional outcome and his innovative treatment plans often include a combination of both.

Nerve repair or nerve grafts

Direct microscopic repair is typically the best option in cases where the nerve has been cut or removed. Regeneration occurs at approximately the rate of one millimeter per day.

Muscle Transposition

Certain muscles can be transferred to other areas of the face to improve symmetry. Moving one of the jaw muscles to the corner of the mouth can even out the function and animation of the mouth.

Eyelid, oral and facial procedures

  • Weight placement in upper eyelid to help it close more fully
  • Lower eyelid tightening surgery to reduce tearing and improve symmetry
  • Nasal surgery to improve breathing
  • Browlift to improve eyebrow symmetry
  • Mid-face or facelift to lift drooping features and improve symmetry
  • Lower lip wedge excision to improve symmetry of lips
  • Botox to certain muscles in the face to improve symmetry

 

Reviews

I was referred to Dr. Henstrom at the worst time of my life. I was 2 years into dealing with Ramsay Hunt Syndrome dealing with facial paralysis and severe pain. Doctor took the time to listen. He was heaven sent…he in turn helped me with the pain, paralysis, and he referred me to necessary specialists when I would talk to him about other issues.” AI

“I met Dr. Henstrom several years ago, when I discovered he could use Botox to help with facial paralysis. Years ago, I had a procedure to remove lymph nodes due to melanoma. My smile was affected because of nerve damage. I’ve been getting Botox on my chin area to help straighten my lopsided smile, and it works. I didn’t know how much my self-esteem suffered because of my lop-sided smile, but now I feel so much better and have more confidence. I’ve never had a doctor as caring as Dr. Henstrom when it comes to really wanting his patients to feel good about themselves. He gets it.” EH

 

Schedule Your Facial Nerve Consultation

To learn more about the advanced treatment options for facial nerve repair, call (801)776-2220 or contact us HERE to schedule your consultation with Utah’ facial nerve specialist, Dr. Douglas Henstrom. Skype and FaceTime consultations are available for out-of-town patients.