Nerve Transplant facial paralysis treatment, procedures

Patients (under the age of 55) who have had long-term paralysis are able to undergo advanced surgical procedures to re-create dynamic and spontaneous smile mechanism. These nerve transplants give patients the ability to utilize the facial nerve in the normal side of the face to “drive” the facial movement in the paralyzed side. Patients with long-term paralysis (> 2 years) have non-functional muscles; therefore, new vascularized muscle needs to be attached to the cross-facial nerve grafts after the nerve has been “activated”. The nerve grafts need to be activated for 8-12 months before the muscle in transferred. We have also started using these nerve grafts for individuals with partial paralysis who need additional “input” to help better their smile.

Two stage procedures is typically required for cross-facial nerve grafts

Stage 1: Nerve grafts are harvested from the lower leg (sural nerve) and attached to the normal facial nerve (photo of sural nerve)

Stage 2:

Gracilis muscle free flap is harvested from the inner thigh and attached to the cross-facial nerve graft and artery/vein in the neck.

Physical therapy is continued for the 18 months. Facial movements are gradually realized about 8 months following the second stage of surgery and continued for 2 years.

House Brackmann Grading System

�Grade II: Mild dysfunction

�Slight weakness noticeable on close inspection
�May have slight synkinesis
�Normal symmetry and tone at rest

�Grade III: Moderate dysfunction

�Obvious but not disfiguring difference between the two sides
�Noticeable but not severe synkinesis, contracture, or hemifacial spasm
�Normal symmetry and tone at rest

�Grade IV: Moderately severe dysfunction

�Obvious weakness and/or disfiguring asymmetry
�Normal symmetry and tone at rest

�Grade V: Severe dysfunction

�Only barely perceptible motion
�Asymmetry at rest

�Grade VI: Total paralysis without any movement

Differential Diagnosis

Bell’s Palsy

�Trauma
�Temporal bone fracture
�Facial laceration
�Iatrogenic
�Barotrauma
�Birth trauma (forceps)

�Tumor

�Cerebellopontine angle tumor: Schwannoma, meningioma
�Parotid
�Head & neck tumors

�Congenital

�Toxic

�Melkersson-Rosenthal Syndrome:

Neurologic

�Opercular syndrome: cortical lesion in facial motor area
�Millard-Gubler syndrome

�Infectious

�HSV; Zoster
�External & middle ear
�Lyme disease
�Other: Encephalitis, Poliomyelitis, Mumps, Mononucleosis, Leprosy, Influenza, Coxsackievirus, Malaria, Syphilis, Scleroma, Tuberculosis, Botulism, AIDS

�Metabolic

�Diabetes mellitus
�Hyperthyroidism
�Pregnancy
�Hypertension
�Vitamin A deficiency

Facial Paralysis Nerve Transplant