TREATMENT OF FACIAL PARALYSIS

The face can become paralyzed from several different causes—facial and head trauma, removal of parotid tumors, removal of acoustic neuroma, ear surgery, viral infection, and stroke. Facial paralysis is a devastating consequence for patients, not only because of the resultant obvious facial disfigurement, but also the associated functional problems, such as chronic eye irritation, constant tearing, drooling, speaking difficulties, and nasal obstruction.

Many new state-of-the-art treatment modalities are now used to correct these problems, which allow patients to function without embarrassment in society. These techniques range from simple re-suspension of the droopy face to highly complicated microvascular free-tissue transfer that restores facial movements.

The microvascular operation involves transferring a muscle from the thigh (gracilis muscle), with its blood vessels and motor nerve, to the face where it is attached to restore movements of the midfacial musculature. The blood vessels to the gracilis muscle are sewn to the vessels in the neck or face to allow revascularization of the muscle. The motor nerve of the gracilis muscle is then meticulously anastomosed to a recipient nerve in the head and neck region to derive neural stimulation. The ideal recipient nerve is the remaining proximal stump of the paralyzed facial nerve, which will ultimately provide neural input to the gracilis from the brain center that controls facial expressions.

Dr. Maisie L. Shindo has gained national recognition for her expertise in the use of microvascular free-tissue transfer—a major innovation in the treatment of facial paralysis. For a review of the surgical treatment of facial paralysis, please click here.