Facial Nerve Problems (cont.)

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What surgical reconstruction options are available?

Reconstructive options for patients with facial muscle weakness or paralysis include one or more of the following:

  • Nerve repair or nerve grafts: Facial nerve regeneration occurs at a rate of one millimeter per day. If a nerve has been cut or removed, direct microscopic repair is the best option.
  • Nerve transposition: Often the tongue nerve (hypoglossal nerve) or the other facial nerve can be connected to the existing facial nerve. For example, the patient can then train themselves to move their face by moving their tongue.
  • Muscle transposition or sling procedures: The temporalis muscle or masseter muscle (some of the only muscles on the face not supplied by the facial nerve), can be moved down and connected to the corner of the mouth to allow movement of the face.
  • Muscle transfers: Free muscles from the leg (gracilis) can be used to provide both muscle bulk and function. Often a cross facial nerve transposition is done to provide similar nerve supply to the donor muscle flap.
  • Ancillary eyelid or oral procedures: In addition to one of the above, often it is necessary to include a brow lift or facelift, partial lip resection, eyelid repositioning, lower eyelid shortening, upper eyelid weights, or eyelid springs in reconstructive surgery following severe facial nerve palsies.

What is the prognosis for facial nerve problems?

The prognosis for facial nerve damage depends on the underlying cause. Many patients who have required surgery to remove tumors may have unavoidable permanent injury to the facial nerve, whereas more than 70% of persons who experience Bell's palsy will have complete recovery. The best outcomes occur with rapid diagnosis and treatment.


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