Reanimation Surgery for Facial Nerve Paralysis

NYU Langone neurotologists, neurosurgeons, and plastic surgeons, all of whom specialize in disorders that affect the nerves connecting the face and the brain, offer a variety of sophisticated surgical procedures—some pioneered at NYU Langone—that restore facial symmetry and reanimate, or restore movement to, the facial muscles.

Reanimation surgery may be needed when a paralyzed facial nerve does not recover. This type of paralysis may occur as a result of a traumatic head injury or a stroke.

Persistent paralysis can also occur if a benign tumor called a facial neuroma grows on the seventh cranial nerve, which carries electrical signals from the brain to the facial muscles. NYU Langone surgeons can often successfully remove the tumor without damaging nearby nerves, but sometimes nerve damage can result from surgery.

Rarely, paralysis associated with Bell’s palsy, which is caused by inflammation in the seventh cranial nerve, may be permanent. Most of the time, if nerve activity does not increase within 6 to 12 months, the nerve is unlikely to recover.

Doctors may recommend the following procedures to reanimate muscles or restore the look of the face.

Static Cosmetic Procedures

Surgeons perform static cosmetic procedures to restore a symmetrical look to the face. However, these procedures do not reanimate the muscles.

A common static procedure is implanting a small gold or platinum weight in the upper eyelid to help the eyelid close. The lower lid is often tightened at the same time the weight is inserted. This helps prevent dry eye and protect the eye from injury.

A surgeon may also prevent eye injury and dryness by performing a tarsal strip procedure, which improves the tone of the lower eyelid and prevents tears from flowing out of the eyes. Another common procedure for the paralyzed eye is an eyebrow lift, in which a surgeon adjusts the brow to match the unaffected side, restoring symmetry.

A facelift on the paralyzed side of the face can also help improve symmetry. This procedure tightens and lifts the skin and muscles, removing sagging skin that often results from facial nerve paralysis.

Nerve Graft

Even if the facial nerve has lost function, the facial muscles remain healthy for about 18 months before beginning to atrophy due to lack of use. If electromyography, a diagnostic test that measures muscle activity, indicates that there is no significant activity in the facial muscles and the amount of nerve activity has gone unchanged for more than 12 months, NYU Langone doctors may recommend a surgical procedure called a nerve graft.

In this procedure, paralyzed facial muscles are connected to healthy nerve tissue to restore movement. A surgeon uses healthy nerve tissue located in another part of the face or obtains nerve tissue from another part of the body, such as the neck or the leg.

In one nerve-grafting technique, a surgeon carefully moves the damaged intra-temporal facial nerve, which controls lip and mouth movements, down to the hypoglossal nerve, which controls the tongue. A surgeon grafts the paralyzed nerves to the healthy nerves using tiny sutures. Another option is to remove healthy nerve tissue from another part of the body and use it to connect muscles on the paralyzed side of the face to functioning nerves on the other side.

Regardless of the surgical approach, the nerve graft gradually heals over the following year. Nerve impulses recover and muscle control slowly returns to the paralyzed side of the face.

Muscle Transposition and Muscle Transfer

Another method of reanimating the face is muscle transposition, in which a plastic surgeon moves healthy muscle tissue from one part of the face to the paralyzed corner of the mouth. In some instances, surgeons may reroute some facial muscles from the unaffected side of the face. Another option is to use muscle tissue associated with chewing. This allows a person to smile on the paralyzed side by clenching the jaw.

If the muscles affected by nerve paralysis have atrophied and are not eligible for muscle transposition, surgeons may recommend a muscle transfer. In this procedure, surgeons remove healthy muscle tissue, with its nerve and blood vessels, from another area of the body, such as the leg, and implant it into the paralyzed side of the face.

The surgeons place the healthy muscle in the correct orientation to allow active facial motion, such as smiling. The blood vessels are connected to native vessels in the face, and the nerves are connected to other healthy nerves in the face, either from a graft to the unparalyzed side or to a nerve that controls one of the chewing muscles.

These procedures are performed with general anesthesia.

What to Expect After Surgery

The recovery time for reanimation procedures varies depending on which procedure is performed, whether you have more than one procedure, your age and health, and how long your nerves and muscles have been paralyzed.

Most static cosmetic procedures that restore a symmetric appearance are outpatient procedures, meaning you can go home the same day. If your surgeon performs nerve grafting, a muscle transposition or muscle transfer, or both, you can expect to remain in the hospital for observation for two or three days.

After surgery, NYU Langone pain management specialists ensure that you have the medication you need to recover comfortably. Often, over-the-counter ibuprofen or acetaminophen may be sufficient. If you experience significant discomfort, your doctor may prescribe a stronger pain relief medication.

Facial nerve rehabilitation therapy is a key component to recovery after surgery. Once muscle movement returns, your surgeon may refer you to specially trained facial physical therapists at NYU Langone’s Rusk Rehabilitation.

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