Fredrick A. Valauri, M.D., F.A.C.S.

Facial Palsy Center of New York

About Facial Palsy

Facial Paralysis Reconstruction

 

 

The facial muscles

 

The facial nerve innervates the muscles that control facial movement and expression.  If the facial nerve is damaged through injury or disease; fails to develop; or is removed by surgery for tumors some or all of the function of the facial muscles will be lost.

 

The loss of function is called facial paralysis or facial palsy.

 

Among the many causes of facial nerve paralysis are the following:

 

·       Trauma – such as laceration of the nerve; fractures of the base of

           the skull

·       Bell’s Palsy

·       Brain Stem Tumor

·       Acoustic neuroma surgery

·       Surgery of the mastoid bone, or parotid gland

·       Congenital – birth defects such as failure of development of the

           nerve or its nucleus  (mobius syndrome).

·       Stoke

·       Viral infections including Lyme Disease and Herpes Zoster Otitis

·       Hemifacial microsomia with failure of development of the facial            nerve

 

The treatment of each patient is unique to that patient based on the cause of their paralysis; the extent and distribution of their paralysis; the duration of their paralysis; the age of the patient; the patient’s general medical condition; and the patient’s goals.

 

There are a variety of impairments associated with facial paralysis.  These include:

 

Facial asymmetry

Eye exposure due to lack of eyelid closure

Folding out (ectropion) of the lower eyelid

Corneal erosion or irritation with conjunctivitis

Ptotic (fallen) eyebrow with or without visual obstruction

Flattening of the nasolabial fold

Nasal airway obstruction with external nasal valve collapse

Inability to smile

Oral incompetence with drooling and difficulty with speaking

Lower lip asymmetry

 

The strategies for each patient is based on an evaluation of the etiology of the problems, their unique anatomical impairment and their general medical condition.

 

The primary objectives are to prevent eye-exposure and corneal injuries, restore facial symmetry and a dynamic smile, improve nasal airway and oral competence.

 

Procedures for the eye and brow include: a gold weight implant for upper eyelid closure; a canthopexy, or tightening of the lower lid for better closure; browlift procedure (open or endoscopic) for improvement of eyebrow position and symmetry.

 

Procedures for dynamic smile include: 1) regional muscle flaps of the temporalis or masseter muscles; cross-face nerve grafts with a gracilis muscle microvascular transplant; 2) combined with static suspension procedures for repositioning the corner of the mouth, and corner of the nostril to open the nasal airway and improve breathing; 3) creation of nasolabial fold for symmetry.

 

For the lower face and lips reconstruction includes:  1) facelift – like procedure to raise the ptotic cheek and improve facial symmetry; 2) Wedge resection of the lower lip and local (digastric) muscle transfer for improved position and function.

 

These reconstructions are developed as multistage plans individualized for each patient’s particular condition and requirements.

 

Physical therapy including biofeedback and electrical stimulations, often prescribed before and after facial paralysis surgery in order to enhance the potential result.

 

 

47 East 77th Street

Suite 201

New York, New York 10021

212-439-0080

Email Us: Info@DrValauri.com