Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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 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 provide 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.
Facial Nerve Problems and Bell's Palsy At A Glance
Facial nerve disorders affect the muscles of the face.
There are many causes of facial nerve disorders.
A number of tests can be helpful to diagnose the cause of a facial nerve
disorder.
Treatment of facial nerve disorder depends on the cause and severity.
Herpes simplex infections are common and when they appear around the mouth and lips, people often refer to them as "cold sores" and "fever blisters." Canker sores are different than cold sores. Air droplets can spread the virus, as can direct contact with the fluid from the blisters. Cold sore treatment include over-the-counter medication as well as prescription medications.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Genital herpes, a viral infection by the herpes simplex virus (HSV), is transmitted during sexual contact with the mucous-covered linings of the mouth, vagina, or the genital skin. A typical outbreak begins with an itching or tingling sensation followed by redness of the skin and blister formation. The blisters and ulcers that form when the blisters break are painful to the touch, and last from 7 days to 2 weeks. Though there is no cure for herpes, there are ways to treat outbreaks.
Lyme disease is a bacterial illness, which is spread by ticks when they bite the skin. Initially the disease affects the skin causing a reddish rash associated with flu-like symptoms. It takes weeks to months after the initial redness of the skin for its effects to spread throughout the body. Lyme disease can be treated with antibiotics. Lyme disease can be prevented by using tick avoidance techniques.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Ramsay Hunt syndrome is an infection of a facial nerve that causes a red painful rash with blisters and facial paralysis. The herpes zoster virus causes the infection. The infection is treated with antiviral agents, steroids, and pain medications.
A corneal ulcer is an open sore on the cornea. Infection is a common cause of corneal ulcer. Symptoms and signs of corneal ulcer include redness, eye pain and discharge, blurred vision, photophobia, and a gray or white spot on the cornea. Treatment depends upon the cause of the corneal ulcer.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Pain that originates in the face is referred to as trigeminal neuralgia. This pain may be caused by an injury, and infection in the face, a nerve disorder, or it can occur for no known reason. Trigeminal neuralgia can be treated with antiseizure medications. Some antidepressant drugs also have significant pain relieving effects.
Pregnancy can bring challenges like weight gain, stretch marks, varicose veins, heartburn, constipation, hemorrhoids, problems sleeping, and wondering if it is safe to have sex while pregnant. Learn how to manage and move through these challenges during pregnancy.
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