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

Facial Nerve Paralysis

Facial nerve paralysis represents a severe form of facial disfigurement with potentially devastating social, psychological and functional problems for affected patients. Mount Sinai’s Facial Nerve Paralysis Program involves a multidisciplinary approach to ensure patients receive all aspects of care in one setting. Our team of experts includes facial plastic and reconstructive surgeons, head and neck surgeons, ophthalmologists, neurologists, physical therapists and social workers.

Treatment of Facial Nerve Paralysis

Facial paralysis can result from a wide variety of causes including infections, traumatic injuries, skin cancers, salivary gland cancers, head and neck cancers. The most common cause of facial nerve paralysis is Bell’s palsy, also known as idiopathic facial nerve paralysis. Facial nerve paralysis can range in severity from the loss of tone or selected to facial movements to complete loss of facial movement on the affected side with resulting facial drooping and inability to close the eye placing patients at risk for eye injuries and even blindness. Patients recovering from facial nerve paralysis may develop involuntary facial movements known as “synkinesis”. These movements can be uncomfortable and socially unacceptable.

Our expert facial plastic and reconstructive surgeons offer a wide range of treatment options for patients suffering from facial paralysis:

  • Occupational/physical therapy
  • Botox treatments
  • Nerve grafting
  • Eye lid surgery
  • Facial slings
  • Muscle transfer surgery

Occupational and physical therapy play a vital role in helping patients recover from facial nerve paralysis or regain function after surgery. Therapists employee techniques designed specifically for facial retraining helping patients identify and regain control over specific facial movements. For patients with synkinesis or facial spams, Botox, administered during a routine office visit, is often an important adjunct to facial retraining.

For nerve injuries where the injured branches of the facial nerve can be identified, nerve grafting is the first choice of treatment. Recovery after never grafting occurs over the course of 6-12 months. During this period occupational and physical therapy is often started to maximize the return of facial movement. As head and neck, salivary gland and skin cancers can sometimes involve the facial nerve we work closely with Mount Sinai’s Center for Head and Neck Cancer to treat the effects of facial nerve loss at the same time patients are undergoing cancer treatment.

Eyelid surgery is an indicated for patients who are unable to close their eye on their paralyzed side. The loss of blinking and eye closure can result in the need for prolonged “eye care”, corneal injuries, pain and even possible blindness. Eyelid surgery for facial nerve paralysis typically involves placing a gold weight in the upper eyelid and tightening the lower lid.

Facial slings and muscle transfer techniques are used to support to corner of the mouth and lower face. Whereas facial slings are “static” and do not move, muscle transfer techniques can result in dynamic movement restoring patients ability to smile. Depending on the needs of the patient these procedures can be performed as a single surgery. In some cases, multiple procedures are needed.