Ear, Nose and Throat (Otolaryngology) – Head and Neck Surgery

Bell’s Palsy Facial Nerve Reconstruction

Bell’s palsy is a sudden paralysis or weakness on one side of the face due to malfunction of the seventh cranial (facial) nerve that affects about 40,000 Americans each year. While 80 percent of individuals recover from Bell’s palsy within a short amount of time, the remainder do not. These patients have long-term challenges with eye closure and smiling. For decades, physicians have been able to compensate for the eye closure issues with a number of treatment options; however, the loss of smile has remained a devastating issue for many patients.

Causes and Symptoms of Bell’s Palsy

Patients with facial nerve paralysis are often diagnosed with conditions such as Lyme disease, but when the cause is unknown, the diagnosis of Bell’s palsy is made. Recent findings have suggested that shingles and infections, such as herpes, can cause Bell’s palsy, but for the most part, there is no known cause for great majority of these cases.

Symptoms of Bell’s palsy include pain behind the ear, followed by the weakening of facial muscles. Only one side of the face is affected with the paralysis, which occurs over a short period of time (48-72 hours). Patients may experience dry eyes and mouth, and a decreased ability to taste with the front part of the tongue on the affected side.

Cranial Nerve 5 and 7 Transfer Surgery for Bell’s Palsy

For patients suffering a long-term loss of smile movement from Bell’s Palsy treatment options have been limited. Over the past few years, select highly specialized surgeons have embraced a new surgical approach to restore a natural smile. This procedure, known as cranial nerve 5 and 7 transfer (masseter facial nerve transfer), involves rerouting nerves involving jaw movement to help restore facial movement, specifically movement of the muscles involved in smiling. Joshua Rosenberg, MD, of The Mount Sinai Hospital in New York is one of the few surgeons across the nation who performs this procedure.

The surgery is typically performed on an outpatient basis. The approach is similar to a facelift with the incision well hidden in the hairline and along the ear. Small branches of the facial nerve (cranial nerve 7) that specifically stimulate the smile muscles are identified. A separate nerve that stimulates a muscle involved in closing the jaw (the masseteric branch of cranial nerve 5) is also identified and isolated. These two nerves (facial nerve and masseteric branch) are then divided and sewn together. The facelift incision is closed and light dressing is placed on the patient. The new nerve connections heal over time and patients can expect to see improvements in their smile over 4-6 months.

“Losing the ability to smile can be extremely disfiguring,” says Dr. Rosenberg. “For years, the medical community has struggled with how to best treat these patients and many were often left untreated. This novel facial nerve reanimation procedure can transform the lives of patients, who previously suffered the social and professional effects of the loss of smile due to Bell’s palsy. This procedure has given patients new opportunities at work and in relationships that may not have been obtainable.”