Facial paralysis, whether due to a pathologic condition of the skull base or as a result of surgery, could be quite devastating for anyone. Fortunately many techniques are now available for facial rehabilitation. First and foremost anyone with facial nerve paralysis should observe diligent eye care. Please refer here for postop instruction sheet written by Dr. Monfared which has a detailed segment about care of the eye. Other dysfunctions resulting from facial paralysis are mostly cosmetic and not dangerous however since the eyelids are controlled by the facial nerve, absence of function may result in dryness of the eye and corneal ulceration.
Delayed or partial facial nerve paralysis:
Great majority of the cases of facial paralysis that happened a few days after surgery would spontaneously resolve. If the facial nerve had good function right after the surgery, there is a very good chance that it will regained function soon. There is another type of delayed facial paralysis which may happen 1 to 2 weeks after surgery and is similar to viral facial nerve paralysis also known as Bell’s palsy. This kind of paralysis also has great prognosis and is usually managed with steroids and antivirals. Lastly, if parts of the face are still functional during surgeries that the trunk and not the branches of the facial nerve were involved, there is very good chance of complete facial recovery.
Timeline for spontaneous facial nerve recovery:
The duration of time from the onset of facial nerve paralysis is dependent on the type of injury. In cases that the nerve bundle is completely intact but the flow of cytoplasm has been disrupted (also known as neuropraxia) the spontaneous recovery is usually rather quick. This may happen in a few days to a few weeks. In all other types of facial nerve injury, as long as the nerve sheath is intact, the nerve cells have to regrow from the facial nerve nucleus in the brainstem all the way to the face. This will usually happen over a few months. Usually spontaneous recovery may continue up to 18 months after injury.
Facial rehabilitation surgery:
Nerve anastomosis: In cases of facial nerve transaction, the 2 ends of the nerve could be sutured together. Also grafts harvested from other nerves or synthetic material could be used to bridge the gap between the 2 ends of the nerve. This will usually restore motion of the face at allow the person to close her eyes and smile. However there are always imperfections in the function.
Hypoglossal-facial nerve anastomosis: This is a surgical for bringing back tone and function to the face when there is no chance of spontaneous facial nerve recovery or when the recovery has not happened in one year from the onset of paralysis. The nerve that controls the tongue is one of the only cranial nerves the has resting tone which is very suitable for the face since the facial muscles also have resting tone. Either portion or the entire nerve on one side is connected to the trunk of the facial nerve and the nerve fibers we’ll go through the conduit into the facial muscles. It usually takes few months for the nerve fibers to reach the facial muscles and in the beginning patient moved the facial muscles by focusing on moving that side of the tongue. Eventually the facial movements become fluid in the patient no longer has to think about moving the tongue to be able to smile or close the eye.
Static facial rehabilitation: these methods of rehabilitation are designed to restore symmetry at rest to the face. Since the facial nerve has resting tone, when the face becomes paralyzed it becomes completely asymmetric. There are methods to was to asymmetry by using slings for to upper lip, corrective surgery for the lower lip, and addition of gold weight to the upper eyelid to facilitate passive closure of the eye.