Ear, Nose and Throat (ENT)
Rehabilitation, Interventions & Treatment Options
We provide treatment, intervention and rehabilitation options divided in the following ways:
The problem that is most often noted by patients with facial paralysis is the inability to smile. However, the most important concern initially is the inability to fully close the eye, which may lead to eye dryness, corneal abrasion and even blindness. Eye protection measures should be undertaken as soon as the paralysis begins and typically includes eye drops used multiple times per day, eye ointment, a moisture chamber (a clear patch-like guard that covers and protects the eye) and proper taping of the eye.
The treatment of the inability to fully close the eye is typically through placement of a platinum weight in the upper eyelid, which allows gravity to help pull the eyelid down and close the eye. This procedure is typically performed in the clinic under local anesthesia. The eye may also require treatment of a sagging lower eyelid. Tightening of the lower eyelid is a also a procedure that can be performed in the clinic under local anesthesia. The eyebrow and eyelid may also droop and become problematic, because they can obstruct vision and be associated with severe facial deformity and asymmetry.
Nasal obstruction is very common in patients with facial paralysis. One rough way to determine if a patient has nasal obstruction is to pull the cheek on the affected side outward (to the side of the face) to open up the nose. If this leads to improvement in breathing, then procedures to open the nose may be helpful.
Treatment of nasal obstruction typically begins with a complete examination of the nose to look for any existing issues that may have been worsened by facial paralysis, such as a deviated septum, turbinate hypertrophy or internal nasal valve collapse. If nasal obstruction is present, the patient is often started on nasal saline irrigations and/or a nasal steroid spray to help decrease any swelling or build up of crusts in the nose. If these are not helpful or if the anatomic deformity is not thought to have the potential to be helped through these measures, then surgical intervention to help better improve the nasal breathing may be performed.
Lower lip asymmetry is common in facial paralysis. There are several muscles that cause the lower lip to depress. These muscles may be responsible for asymmetry when smiling or speaking. In most cases of facial paralysis where lower lip asymmetry is a concern, the lip depressor muscles no longer pull down the corner of the lip, whereas the non-paralyzed side continues to pull down as it did before the paralysis. This leads to lower lip asymmetry. The treatment resects the still active depressor muscle on the opposite side to lead to a more symmetric lower lip. This procedure is typically performed under local anesthesia in the clinic.
The inability to smile is the most distressing element of facial paralysis. The treatment of this problem may include measures ranging from physical therapy and botulinum myomodulator therapy to surgical procedures.
Surgical procedures to restore smile
- Free tissue transfer: This procedure involves transplantation of a muscle with its associated artery, vein and nerve from the leg to the face to replace the facial musculature that is no longer working. It is typically done as a one or two stage procedure that also involves transfer of a nerve graft from the leg across the face to connect the muscle to the opposite, functioning facial nerve in an attempt to restore spontaneous and symmetric smile. This procedure is done in the operating room under general anesthesia and requires a five to seven day stay in the hospital after the procedure.
- Nerve grafting: This procedure involves transferring a nerve from the leg, arm or neck from the uninvolved facial nerve to the paralyzed nerve. This may lead symmetric spontaneous smile in many patients.
- Nerve transfer techniques: If the portion of the facial nerve that goes to the facial musculature is still functional, a nerve that controls a different facial muscles or a nerve that controls tongue movement may be transferred or grafted to the facial nerve and lead to good results in restoring smile.
- Muscle transfer techniques: In cases where the facial musculature is non-functional and a free tissue transfer cannot be performed, one of the muscles associated with chewing (that is not innervated by the facial nerve) can be transferred to help restore facial function.
- Static procedures: These procedures do not lead to active smile, but lead to improvement of the symmetry of the face. They may include facelift, brow lift, suspension of sagging facial tissue with fascia or sutures.