Facial Paralysis ~ Bells Palsy. And How I smiled Through Mine

Rarely, Bell's palsy can recur. The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face. Facial weakness or paralysis may cause one corner of your mouth to droop, and you may have trouble retaining saliva on that side of your mouth. The condition may also make it difficult to close the eye on the affected side of your face. Seek immediate medical help if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not caused by a stroke, but it can cause similar symptoms.

See your doctor if you experience facial weakness or drooping to determine the underlying cause and severity of the illness. Although the exact reason Bell's palsy occurs isn't clear, it's often related to exposure to a viral infection. Viruses that have been linked to Bell's palsy include the virus that causes:. In Bell's palsy, that nerve becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Recurrent attacks of Bell's palsy are rare. But in some of these cases, there's a family history of recurrent attacks — suggesting a possible genetic predisposition to Bell's palsy. A mild case of Bell's palsy normally disappears within a month. Recovery from a more severe case involving total paralysis varies.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Bell's palsy causes sudden, temporary weakness in your facial muscles. Facial paralysis The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face.

In addition, Tinel's sign is a more sensitive indicator of sensory nerve than motor nerve regrowth; therefore, it is important educate the parents that this is not necessarily a sign of surgical failure. In the second stage of the surgery, the patient then receives a vascularised muscle flap that will be innervated by the cross facial nerve graft over a 6 to 12 month period Fig. The typical muscles used are the pectoralis minor, gracilis, and latissimus dorsi, as these leave as little donor morbidity as possible. At this stage, the patient will slowly regain movement on the affected side of the face [ 8 - 10 ].

In bilateral congenital facial paralysis, the facial nerve is not available as a motor to drive the new muscle; therefore, another branch of a cranial nerve may be used, such as the V, IX, or XII [ 11 ]. Stage 1 and 2 facial reanimation. A A cross facial nerve graft CFNG , usually a harvested sural nerve, is joined to a functioning buccal branch of the facial nerve FN on the contralateral side and tunnelled subcutaneous to the preauricular area on the affected side.

The nerve regeneration can be monitored clinically using Tinel's sign.

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B A free functional pectoralis minor flap is raised through an axillary approach with its neurovascular pedicle. The flap is inset on the affected side where the thoraco-acromial artery and vein are anastomosed to the facial artery and vein, and the medial pectoral nerve is connected to the CFNG. Reinnervation of the muscle typically takes 6 months, at which stage the muscle can be seen to start twitching. When considering facial reanimation in children, it is important to consider the impact the surgery and hospital appointments will have on the family and the child.

The average time taken to complete the treatment is around two years, and this should ideally be completed before educational commitments become affected and before the child becomes fully aware of his or her palsy and the psychological implications begin to take hold.

LEARNING OBJECTIVES

Surgery can be started from the age of four years, and it is beneficial to allow time for the family to consider the surgical options in detail; therefore, early referral is prudent. The nerve regeneration potential of a patient is inversely proportional to their age; the older the patient, the less likely they are to experience a good result from nerve grafting. It is currently accepted that one-stage reconstruction yields the most favourable results in the older age group [ 14 ]. A muscle flap with a long nerve is used to directly reach the opposite side of the face and allow the surgeon to do a direct neurorrhaphy i.

After the age of 60, it is probably prudent to choose the shortest innervation route of the functional muscle transfer by joining the nerve of the muscle to a branch of ipsilateral cranial nerve V, most commonly to a branch of the masseteric nerve; this gives the patient the best possibility, even with slow nerve regeneration, of gaining some active motion [ 16 ].

It is important to realize that this will require a certain amount of re-learning or 'plasticity' in order to smile spontaneously. There are other treatment modalities available, which can be broadly grouped into static or dynamic options. Simple unilateral skin tightening procedures can be performed, but these are normally of little long-term value; the lack of muscle activity as well as the elasticity of the skin cannot sustain a corrective result.

More permanent sling procedures offer an improved static position of the mouth [ 17 ]. In this type of surgery, a portion of the tensor fascia lata is harvested and inset in a fixed position to give the face a more symmetrical posture at rest. More complex local muscle transfers exist, such as the Labbe temporalis slide [ 18 , 19 ], the Gilles conventional temporalis transfer, and the masseteric transfer [ 20 ].

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It is often difficult for patients to learn how to effectively utilize these muscles, as the plasticity of the brain also decreases with age and often multiple revisions are required over time [ 21 ]. The most common isolated branch palsy is that of the marginal mandibular branch; this results in uncontrolled excessive retraction of the lower lip on the normal side, as it is unopposed. There are both medical and surgical treatments. Botulinum toxin A Botox can be injected into the healthy side of the face every 3 to 6 months in order to restore symmetry.

Botox may also be used to improve involuntary twitching and fasciculation or synkinesis, which is often experienced during a patient's recovery from a Bell's palsy, but it may also be a permanent symptom [ 22 ]. Equally, the healthy muscle can be resected to improve posture [ 23 - 25 ].

The position of the lower lip can be corrected with a local muscle transfer of the anterior belly of the digastrics, as described by Conley [ 23 ] in Various other midface techniques such as the suborbicularis oculi fat SOOF lift can be used to correct the minimally displaced corner of the mouth of the affected side [ 26 - 28 ]. Small adjustments around the nasolabial fold or the corner of the mouth may also improve symmetry. Various methods have been used to judge the outcomes of reanimation surgery, and opinions differ on the matter.

Most authors agree that video assessment and panel judgment is important [ 9 , 10 , 29 - 32 ]; however, multiple outcome scales have been proposed [ 33 ]. All surgery involves a certain amount of scarring, and for patients who suffer from problematic wound healing, such as with hypertrophic or keloid scarring, the cosmetic outcome may be a disaster.

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The most important outcome is patient satisfaction following surgical intervention, as it is not uncommon for perspectives to differ between surgeons and their patients [ 34 ]. Bulkiness and asymmetry in the shape and volume of the paralyzed cheek compared to the unaffected side is almost an inevitable consequence of the disease and surgery. The results of surgery are not entirely predictable and may require some revision surgery over time [ 35 - 37 ]. A patient following facial reanimation. A A patient with an incomplete right-sided facial paralysis caused by an unresolved Bell's palsy.

Predominantly, the buccal and mandibular branches were affected the most, leading to the loss of smile and symmetry of the mid- and lower face. B Two years after completion of facial reanimation, the patient shows good excursion of the modiolus of the mouth and symmetry of the mid- and lower face. There is minimal bulkiness of the right side of the face, and the position of the mouth is restored to being symmetrical.

My Journey to Recovering from Bell's Palsy

C Twenty years following surgery, the patient continues to have a functioning muscle transfer with no loss in excursion or symmetry. There are multiple treatment modalities available to offer an individual with facial paralysis. The delivery of these is dependent on patient awareness and primary care physician education to ensure early referral to specialist units. The treatment methods of children and adults with facial paralysis follow different algorithms based on similar principles and must be considered separately.

Click here to view. No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U.



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Journal List Arch Plast Surg v. Published online Sep Jonathan Leckenby and Adriaan Grobbelaar. Find articles by Jonathan Leckenby. Find articles by Adriaan Grobbelaar. Author information Article notes Copyright and License information Disclaimer. CAUSES There are discreet patient groups that can best be broadly classified into children and adults; this is the most important criteria for determining the treatment options available.

Smile surgery

Open in a separate window. Footnotes No potential conflict of interest relevant to this article was reported. Psychological and social factors in reconstructive surgery for hemi-facial palsy. J Plast Reconstr Aesthet Surg.

Smile Restoration for Permanent Facial Paralysis

Causes of facial palsies. Tzafetta K, Terzis JK. Essays on the facial nerve: Falco NA, Eriksson E. Facial nerve palsy in the newborn: N Engl J Med. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. Facial palsy and reconstruction. Pectoralis minor for facial palsy. Long-term outcomes of free-muscle transfer for smile restoration in adults.

Long-term outcomes of free muscle transfer for smile restoration in children.