Facial Paralysis in MinnesotaFacial paralysis is an uncommon symptom. We offer several treatments at our Minneapolis area clinics, including what are commonly called the gracilis flap and temporalis tendon transfer procedures. If you or a loved one is experiencing facial paralysis, call one of our two Twin Cities clinics to learn more about treatment options.
The ability to move the face depends on 3 things:
- The portion of the brain that controls facial movement must be intact. For example, a stroke damages the brain and can result in full or partial facial paralysis.
- The facial nerve must be intact. The facial nerve is the nerve that carries impulses from the brain to the muscles of facial expression. If the nerve is damaged, the muscles cannot receive the brain’s message.
- The facial muscle(s) must be intact. Even if the brain and facial nerve are working perfectly, if the muscle at the end of the connection is damaged, no movement will be possible. For example, a car accident or removal of large facial cancers can damage muscles and lead to full or partial facial paralysis.
Bell’s palsy is the most common cause of facial weakness or paralysis. However, it is important for physicians and patients to realize that not all cases of facial weakness or paralysis are caused by Bell’s palsy. Very serious and treatable conditions like cancer and stroke can cause facial weakness, and should be ruled out before giving a diagnosis of Bell’s palsy. Other potential causes of facial paralysis include:
- An error in fetal development or trauma during birth
- Accidental trauma to the nerve during a car accident or fall. Sometimes this is because there is a fracture of the bone at the skull base where the nerve enters the face
- Autoimmune diseases including Wegener’s disease
- Neurologic diseases including multiple sclerosis
- Other infections including Lyme disease or shingles of the face
- Chronic ear problems like cholesteatoma
Are there treatments for complete facial paralysis?
Unlike Bell’s palsy, some injuries to the facial nerve cannot recover. For example, if the nerve needs to be cut out for cancer, the nerve cannot spontaneously recover. In other instances, the nerve may be stretched and it can take up to 12 months to know if the nerve will be able to recover on its own or not.
Fortunately, there are many reliable surgical treatments for chronic facial paralysis. The choice of treatment depends on how much time has passed since the injury and whether or not there is still a chance for spontaneous recovery.
The surgical treatments for facial paralysis can basically be broken down into 5 categories:
- Static procedures: Static procedures mean that they do not create facial movement. Likely the most common procedure performed for chronic facial paralysis is an upper lid gold or platinum weight. This is a static procedure where a small, sterile piece of gold or platinum is placed in the upper eyelid to help gravity close the eye during blink. Another common static procedure is aptly named a “static sling.” In this surgery, the paralyzed cheek is suspended in a more symmetric, elevated position.
- Nerve grafts: when a portion of the nerve is removed by trauma or surgery, it can be replaced with a piece from a different nerve if both cut ends of the nerve can be identified. Over time, the facial nerve fibers will grow through the nerve graft, using it like a “highway” to find the other side. Eventually, the nerve fibers will grow all the way to the muscles allowing the return of movement. The nerve fibers (axons) grow very slowly and this process usually takes several months.
- Nerve substitutions (hypoglossal-facial nerve transfer or masseteric-facial nerve transfer): If the facial nerve is damaged or removed very close to the brain, a nerve graft is often not possible. For example, a benign tumor of the balance nerve (vestibular schwannoma) is a common cause of facial paralysis because the balance nerve is right next to the facial nerve. This tumor usually forms just as the nerves emerge from the brain, and so it is not possible to sew a nerve graft in that location. However, it is possible to sew the nerve to the tongue (hypoglossal nerve) or a chewing nerve (masseteric nerve) to the stump of the facial nerve. Then, one can move the tongue or bite down in order to move the face. Often, this becomes unconscious for the patient over time as the brain relearns how to move the face. However, this technique almost never produces the ability to smile or laugh in an emotional sense. The person can make a smile on both sides when they want to, but not when they hear a joke or are tickled.
- Muscle substitutions (temporalis tendon transfer): When the muscles that move the face are paralyzed for 2 years or longer, they tend to shrink or atrophy and no longer function, even if you give them back nerve input. In these instances, you have to bring a new muscle into the face instead of a nerve. The most common and modern example of this technique is called temporalis tendon transfer. In this surgery, one of the chewing muscles (the temporalis muscle) is detached from the lower jaw and sewn to the corner of the mouth. Then, when the person bites down, it will create a smile on the paralyzed side of the face. A similar technique can also be performed where a muscle from the leg (gracilis) is moved with its blood vessels to the face and connected to one of the chewing nerves (masseteric nerve). Similarly, when the person bites down, it will create a smile on the affected side of the face.
- Cross-facial nerve graft and free muscle transfer: The only way to restore a completely emotional and spontaneous smile is to perform a 2-stage surgery called cross-facial nerve grafting with free muscle transfer. In the first stage, a nerve graft from the leg (sural nerve) is harvested and attached to a nerve branch that creates a smile on the normal side of the face. The nerve graft is tunneled across the upper lip and left near the corner of the mouth on the paralyzed side. After about 6 months, nerve fibers (axons) will grow across the nerve graft. At that point, the second stage is performed. A muscle from the leg (the gracilis muscle) is moved with its nerve and blood vessels to the paralyzed side of the face, and attached to blood vessels there so that the muscle will live. The nerve to the muscle is attached to the nerve graft from the first stage. Now, the brain can tell the good facial nerve, can tell the nerve graft, can tell the muscle graft, to move when laughing or smiling. The entire gracilis flap process takes about 2-3 years and has a 20% failure rate in most large studies.
Schedule a consultation with our staff to find out if it is right for you.