Facial paralysis

diagnosis and treatment of facial paralysis

Facial paralysis is clinically defined as the inability to raise your eyebrow, close your eye, smile and suffering from speech impairments, etc.

If the cause is known, this needs to be treated first before any surgical treatment can be carried out.

The Reconstructive and Aesthetic Plastic Surgery Department, also work with Otorhinolaryngologists, Neurosurgeons, Neurophysiologists and Physiotherapists at the Clínica in order to correct the patient's condition.

Diagnosis of facial paralysis is primarily done through a medical examination. Sometimes, it's necessary to undergo a series of tests to evaluate the severity of the paralysis:

  • Schirmer test to measure how many tears each eye produces
  • Saliva test
  • Hearing tests
  • Tests to evaluate how much the nerves are affected

Furthermore, the Doctor may do a Radiological study of the brain with a CT scan or a nuclear magnetic resonance (NMR) scan, to rule out a number of possible causes.

A patient with facial paralysis recovers smile after an operation with graft leg muscle in the face. [Video only available in Spanish]

Reconstructive techniques, used on their own or in a combination, result in patients being able to smile naturally in almost 90% of cases”.

To recover facial movement, any known causes need to be treated first:

  • If it is due to trauma, it is treated with Corticoids
  • If it originates in infection, anti-viral or antibacterial drugs are used

Later, it can be treated with surgery.

Additionally, as the eyelid does not close properly, it ́s necessary to protect the eye. For this, sunglasses, artificial tears and epithelium ointment are used and the eyes are covered with patches when the patient is sleeping.

When conservative treatment is not successful and the nerves have not recovered, there are various reconstructive techniques that can be used to improve the patient ́s condition.

There are two different types of reconstructive techniques:

  1. Static: this involves raising the eyebrow and closing the eye, amongst other treatments, in order to recover the most natural facial composition possible and improve physical appearance. Patients with facial paralysis can open their eyes but not close them. A gold weight is implanted in the eyelid that closes the eyelids due to gravity. With regards to lifting the facial tissue, the different sections of the patient ́s face are raised with tendons and hang so that they seem as similar as possible to the healthy side of the face.
  2. Dynamic: aims to enable the patient to move their face and smile again. The most appropriate surgical technique depends on the patient ́s circumstances (cause of the nerve lesions, age, associated diseases, etc.).

Facial Nerve Transfer and Muscle Transplant

So that the patient can smile normally again, the surgeon extracts muscles from the knee, with blood vessels and nerves. It ́s a slender muscle that extends from the lower section of the pubis and ischium, to the tibia. The graft connects the zygomatic arch – a part of the human skull, or more specifically, the face – and the orbicularis muscle so that it pulls the corner of the mouth. The grafted muscle ́s nerve is attached to the masseter muscle nerve and connected to a vein and artery in the neck.

When the patient decides to move the masseter muscle, as it shares now a nerve with the graft, it will also move and they will smile. With rehabilitation, the patient will develop a natural smile.

The results achieved through surgical operations and rehabilitation, are very satisfactory for the patient.

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