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A Reason to Smile: Facial Reanimation Surgery for Bell’s Palsy Patients

Sudden facial paralysis or drooping of the face can be alarming because those are often signs of a stroke. If you have these symptoms, you should seek medical help right away. If it’s determined that you are not having a stroke, it could be Bell’s palsy.

What Is Bell’s Palsy?

Bell’s palsy is a condition that causes weakness or paralysis on one side of the face, making it appear as though it’s drooping. An exact cause is unknown, but doctors think it is likely due to swelling in the facial nerve or the seventh cranial nerve. This nerve helps you make facial expressions, produce tears, and control muscles in your inner ear. It’s possible that this swelling occurs after a viral infection, such as the flu, mononucleosis, and respiratory illnesses.

What Are the Symptoms?

Symptoms occur suddenly and might include:

  • Mild weakness or total paralysis on one side of the face
  • Facial drooping
  • Difficulty making facial expressions, like smiling or closing your eyes
  • Drooling
  • Pain on the affected side, especially near your jaw or behind the ear
  • Sensitivity to sound on the affected side
  • Headaches
  • Loss of taste
  • Changes in tear or saliva production

While these symptoms can seem scary, most people fully recover from Bell’s palsy.

Will I Recover?

The majority of Bell’s palsy patients make a full recovery. Spontaneous improvement occurs in about 85 percent of cases starting within three weeks of the first appearance of symptoms.

“Most patients show some sort of recovery within two to three weeks after their weakness starts, with the majority having complete recovery in three to four months,” says Sarah Akkina, MD, MSC, a facial plastic and reconstructive surgeon at University of Utah Health and an assistant professor in the otolaryngology for head and neck surgery department at University of Utah. “In patients who continue to have some movement at the time of their face droop, about 94 percent of those will completely recover in six months.”

Who Is at Risk?

Bell’s palsy affects about 40,000 people per year of all ages and genders in the United States. But it is especially common in people who:

  • Have an upper respiratory infection
  • Have diabetes
  • Have high blood pressure
  • Are obese
  • Are pregnant, especially those who are in the third trimester or immediately postpartum

Is Facial Reanimation Surgery Right for Me?

A small number of patients still experience symptoms more than six months after the initial appearance of symptoms. A variety of nonsurgical options can help these patients, including physical therapy and botulinum toxin injections. If these methods do not work, facial reanimation surgery may be an option. These surgical procedures can help restore facial movement and improve the symmetry of the face by connecting paralyzed facial nerves to healthy nerves or by moving local or distant muscles into the area.

Based on your symptoms, your health care provider will help determine which procedure is best for you. These common surgeries can help with facial reanimation:

  • Eye procedures: For patients unable to close their eye, doctors can implant a small weight into the top eyelid to help the eye close. They can also tighten the lower eyelid. 
  • Nerve grafting: Also known as a nerve transplant, nerve grafting involves transferring a nerve from the leg, arm, or neck to the damaged nerve to connect it with a healthy nerve. 
  • Nerve transfer techniques: If the portion of the damaged facial nerve that connects to the facial muscles is still working, doctors can transfer a nerve that controls different facial muscles to the damaged nerve to bring back movement on the damaged side.
  • Selective nerve cutting (neurectomy) and muscle cutting (myectomy): If recovery from facial drooping leads to some facial muscles being overactive, doctors can do a surgery to selectively cut the nerves leading to the muscle overactivity. They can also cut portions of the muscles that are overworking or working inappropriately. 
  • Muscle transfer techniques – Regional: If the facial muscles are non-functional, doctors can transfer an undamaged muscle tendon from a nearby area. 
  • Muscle transfer techniques - Free tissue transfer: This procedure takes a muscle, nerve, and blood supply from one area of the body and transfers it to the damaged face. The tissue is connected to a nerve and blood supply in the face. Sometimes it also involves a nerve graft from the leg to the working side of the face. This is often a two-stage procedure and requires general anesthesia and a multi-day stay in the hospital to recover. 
  • Static sling techniques: If the face is dropping, doctors can use tissue from your leg to help suspend the weak skin, fat, and muscle in the damaged side of the face. This is a static procedure, meaning it doesn’t help restore spontaneous movement, but it can improve facial symmetry.

What Are the Surgical Success Rates?

The success rates for these surgeries are often excellent, but timing can be critical for the best results. According to Akkina, some of these procedures need to happen within 12 to 18 months of the first appearance of symptoms to ensure success. After that period of time, the risk of your facial muscles becoming permanently paralyzed increases. Procedures can still be done to help restore symmetry and function, so she recommends always consulting with a facial nerve specialist to understand the options.

“We really need to see patients ideally within 12 months so we can start planning for whether they may be a candidate for certain surgeries,” Akkina says. “If you still have abnormal facial movement after three months, you should get immediately referred to a facial nerve specialist.”

For Bell’s palsy patients, movements as second nature such as smiling, blinking, and keeping food and liquid in their mouth can be impossible. This can feel devastating to their normal lives. However, thanks to advances in facial reanimation surgery, doctors can often restore these functions back to allow patients to continue living their everyday lives.