Peripheral facial palsy can originate from various kinds of damage to the seventh cranial nerve. It can be of congenital origin or be caused by trauma, tumor, surgery, immunological disorders or by infectious diseases.
In 70 % of the adult cases, there is no identifiable cause and the condition is called Bell’s palsy. Approximately 30/100.000 individuals and year are affected as far as we know today. Early prednisolone treatment improves recovery rates, but up to thirty percent of the patients with Bell´s palsy do not completely recover and can suffer from severe sequels.
The overall goal of treatment for patient with sequels is to reestablish facial symmetry and movement. A corresponding challenge is to accurately predict the final grade of denervation and risk of sequel as early as possible to identify a group of patients that would benefit from early nerve transplantation.
To objectify facial function the Sunnybrook Facial Grading System (SB), a scale ranging from 0 (no function) to 100 (normal function) is often used. There are no tests that can predict outcome in the acute setting, but studies showed that poor SB score at 1 month after onset of the palsy ended up with non-recovery (defined as SB < 70) at 12 months in Bell’s palsy.
Persistent peripheral facial palsy can be a devastating handicap. Many patients experience a very negative effect on their quality of live. Apart from affecting facial appearance negatively, weakness of the facial musculature can result in difficulty in eating, drinking and speaking.
Disabling secondary effects include muscle contracture and spasm, involuntary facial mass muscle movements (synkinesis), facial pain and difficulties to close the eye. The social and psychological consequences of peripheral facial palsy can be significant.
How can plastic surgeons help?
It is very important to make a specific treatment schedule for each patient!
Surgically, this can be achieved by reanimation (via regional or free muscle flaps) or reinnervation (via nerve transplantation). Since muscles without innervation starts to de-innervate over time, nerve transplant surgery must be performed within a certain time limit to be effective.
Cross facial nerve transplantation has the advantage of coordinated animation and emotional expression. However, the reinnervation through a long cross-facial nerve graft extends up to 12 months, during this time the paralyzed facial muscles risk irreversible atrophy.
With regard to Terzis' pioneering work we, here in Sweden introduced her principle of “Babysitter” nerve transplantation where a cross facial nerve transplant is combined with a much shorter graft to the ipsilateral hypoglossal nerve. A partial loss of hypoglossal nerve does not clinically affect the function. This kind of operation needs many years of experience and training in microsurgery.
Patients with long-standing sequels can be helped with additional modern aesthetic plastic surgery. All type of facelifts, intraoral- or SMAS techniques as well as modern periorbital and forehead rsurgery can be offered to symmetrize or upgrade the mimic function. Injectables and neurotoxins have an important role in the treatment options of this devastating condition.
Patients with facial mimic disorders profit from the extensive knowledge of modern aesthetic plastic surgery. Plastic surgeons join their in-depth knowledge of anatomy and technical know-how to improve quality of life.
Conditions such as facial palsies demonstrate the interaction of reconstructive and aesthetic plastic surgery.