Facial Paralysis Specialist on New Utah Podcast

NUPodcast: Dr. Henstrom, you are a surgeon, what different specialties are you board-certified with as a facial plastic surgeon here in Utah?

Dr. Henstrom: I have two board certifications. My first certification is in otolaryngology, otherwise know as ear, nose and throat. My second board certification is in facial plastic and reconstructive surgery. So I just do head and neck plastic and reconstructive surgery and it is a pathway most commonly gone into with people with ENT backgrounds. General plastic surgeons with generally come from a general surgery background.They’ll then go into general body plastic surgery so it’s a natural fit for us who are interested in just the head and neck anatomy.

NUPodcast: And when you’re doing so much around the nose and ear area it just makes sense.

Dr. Henstrom: And in our general ENT training about a fourth to a fifth of training is in facial plastics so we’re doing that even as ENT doctors. We’re working with a lot of facial defects and trauma so that kind of falls under that category besides ear surgery and head and neck cancers and stuff like that.

NUPodcast: So our listeners don’t know this but we weren’t exactly sure why Jess wanted you on the show when she sent us your profile from your website. She said he’s freaking amazing with all the stuff he’s done and the special things he does in Utah that nobody else does. Can you talk a little bit about some of that stuff that you pioneer here in the state?

Dr. Henstrom: I think one of the things that’s at the top of the list for that is the work I do for patients that have facial paralysis. This is a patient group that is pretty much under-treated and kind of neglected. Even when I was in medical school the common practice that doctors would teach even me was what damage is done is done and what they get back and there’s not a lot we can do for them. And that’s been taught for decades. And quite honestly at that time there wasn’t a lot people were doing to help them and there is some limitations even now of what we can do. But there’s not a lot of people in the country that have an interest in helping patients with facial paralysis and there’s even fewer that have been trained to do that, at least to the point of where we’re at in the 21st century. A lot of what I do is just educating other practitioners on the things we can do to help facial nerve patients.

So facial paralysis is something that I always had an interest in, even when I was in my ENT residency program. And then I took it to the next level by going to Harvard for my fellowship, as Mass Eye and Ear in Boston and it’s the only two-year facial plastics fellow-ship in the country. The reason why is because it’s heavy in research. It is the epic center of facial nerve training in America. We would see dozens of patients every week in this and that was a rarity. They would really pioneer a lot of what’s being done and it’s run by an amazing physician and mentor, Tessa Hadlock and Mack Cheney.

So when I got there we did a lot of training in the lab and I spent some years there. After that I went back to where I had actually done medical school at the University of Iowa. I was hired on as the Director of Facial Plastic Surgery and one of my goals was to start a facial nerve center, which I did which I built up over the six years I was there. I ended up leaving and coming here but there aren’t many people in the country that have training like I do. There’s certainly no one in the Intermountain West. One of my goals in coming here and joining the practice is to make this a center for people with facial nerve damage in the Intermountain West.

NUPodcast: Where is Utah Facial Plastics based?

Dr. Henstrom: So the practice is called Utah Facial Plastics. It’s myself and Dr. Scott Thompson. We have two offices, one up in Layton and one in Draper. We cover the Wasatch front area and have a lot of patients that come from Nevada and Wyoming. The facial nerve practice is in it’s infancy here and we’re really trying to build it up so there’s a lot of work to do.

NUPodcast: Was there a specific case that gave you that interest in facial nerve repair?

Dr. Henstrom: I remember cases like this during residency and thinking ‘what more could be done’? And then when I got into my fellowship and seeing it over and over again and seeing the change in those people’s lives after receiving no help from other physicians.

NUPodcast: When we talk about facial paralysis, the first thing that comes to mind for me is people that had a stroke. Is that the most common cause of paralysis?

Dr. Henstrom: It’s one of the more common causes but it’s not the most common cause. It’s probably Bell’s Palsy. Stroke victims are tough because typically when you have a stroke you have so many other that come with the stroke that facial paralysis kind of takes a backseat. We actually don’t do a lot of patients who have had strokes because they’re not always great candidates for surgery.

There are a lot of causes of facial paralysis. Some rough stats, about 1 in 5,000 people every year will get facial paralysis. The vast majority of those patients are going to get better on their own. So Bell’s Palsy people, 85% of people are going to heal on their own. The 15% aren’t and they are going to have poor recovery. And that can mean that they get recovery but their nerves actually over recover, you get some crossed wiring in there and all of the sudden their faces get tight. They get fatigued and it hurts and you need to do things with a specialized facial therapist that can help you stretch those muscles and learn how to reuse those muscles. We also combine that with Botox and in the right muscles we can relax them so they aren’t so hyper-active. Some of these patients will develop what’s called ‘synkinesis’ so that when they smile, their eye will get narrow. They aren’t trying to do that but it just gets that way. So we put some Botox around the eye to help relax it so it stays open. Then there is the other category of patients who just don’t recover anything. They stay as what we call ‘flacid” and that’s what you think of when you see those stroke patients. It’s just drooping…they can’t smile, they can’t close their eye and there’s a lot we can do to try to help them. We can put a platinum or gold weight in their upper eyelid to give them some weight so gravity can help them pull that eye closed. We can lift the lower eyelid if that’s needed. And then the big thing is trying to do some smile reanimation surgery with nerve grafts or muscle transfers to the face to try to reanimate a smile, which has the added benefit of helping with their speech intelligibility, you’re going to help them with their oral abilities to keep food and drink in their mouths a lot easier. A lot of these patients will start shutting themselves in, they don’t want to be out or looked at so being able to do that and then seeing them turn their life around is pretty miraculous.

Most all of these procedures we can get through with the insurance company. These are things that are medically necessary in the fact that it’s helping them in those regards. This is not just an aesthetic thing. This is an ability to improve your communication. The other aspect that is often overlooked is the non-verbal communication we have from our face. So when you come in and read a face there are so many clues we cue in on when we’re looking at people. And if a person has half of their face not functioning, you and I will misread that face 9 times out of 10. We will think they are angry or wonder what is wrong with them. So there is a lot of non-verbal communication that can be improved if you can get some muscle function back so this is usually insurance based stuff.

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