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Houston Cranio Facial

Facial Nerve Palsy

Typically a facial nerve injury should be repaired within 72 hours after injury with a direct repair or nerve graft. Sometimes the nerve is injured and is not noticed until a period of time later. If this is the case, facial reanimation can be attempted.

Facial reanimation involves assessing what works and what does not. Typically the issues that need to be resolved are eyelid closure to protect the eye and cornea in addition to oral lip closure to prevent drooling. Most patients also want improvement of facial deformities that occur with significant distortion secondary to the paralysis on one side. The asymmetry involved causes a distorted smile and eyelid closure can cause significant distress.

The types of reconstruction can be divided into dynamic and static reconstruction. Dynamic reconstruction is the use of muscle transfer to create a smile or closure of the eye. Static reconstruction involves using a gold weight for eyelid closure or fascia for elevating the corner of the mouth. Static means not moving. Sometimes nerve grafts are needed to provide stimulation to muscles. The muscles that are transferred can be local muscles of the face or distant muscles such as a gracilis muscle from the leg. A gracilis muscle transfer is a free muscle flap that is harvested with the nerve and blood vessels then reconnected into blood vessels and nerves in the face to create a functional muscle for smiling and elevating the corner of the mouth. Our experienced craniofacial plastic surgeon is extensively trained in the latest techniques and may be able to help you restore function and improve your condition.