Artificial Organ Regrowth - NOVA scienceNOW

Bell’s Palsy in Pregnancy

As a community we still know very little about Bell’s Palsy. The exact causes are unknown, which makes definite diagnosis difficult and treatments uncertain. Through surveys and measuring demographics, however, we can pinpoint who in society is the most at risk. At present there is indisputable evidence showing that pregnant women develop Bell’s Palsy at a higher rate than anyone else.

The highest numbers of Bell’s Palsy in pregnant women are recorded during the third trimester (weeks 28 to 40) and in the weeks following birth too, although it can happen to anyone at any time. Pregnant women are over 30% more likely to suffer from the condition than anyone else, which is why raising awareness at ante-natal classes and with fellow pregnant friends or relatives is important.

Explaining Bell’s Palsy

It’s often the case that just as you’ve got a grip on your health condition, the problem arises of explaining it to your friends and family. Older relatives might not understand, and for young children something like facial paralysis could be scary. So how did you do it?

We want to hear your stories, about how you talked over Bell’s Palsy or facial paralysis with your other half, about how you broke the news to your child. Perhaps you’ve cared for someone with facial paralysis, who was confused and needed you to clarify the situation.

New Facial Paralysis interview by Medscape- Facing the Truth About Bell Palsy

http://www.medscape.com/viewarticle/739509 You will have to login to medscape to view this story, but it's free to login

Here is a wonderful story about a patient that I did a complex facial reanimation case for (gracilis/cross facial nerve graft).

Editor's Note: This is a poem by Gracie Doran, an 11-year-old stroke victim. Her inspiring story follows.

I Am Somebody
I am a dancer
I am an individual who wonders about why this
happened to me
I feel grateful to be alive

I am the daughter of Bobby and Barbara
I hear the birds
I see flowers
I want good grades and an education
I touch my soft dog
I am a 5th grader at Laguna Niguel Elementary School
I am Somebody!

I pretend to be a teacher
I think about getting well again
I cry when I am sad
I am 11 years old on June 4th
I am a symbol of courage
I am Somebody!

I understand good things take time
I am a survivor
I say I will be better soon
I dream of using my hand again
I am a believer in God
Some people do not think I make sense
My hope is that I'm 100% again
It is these things I believe in

I am Somebody

I am Gracie Doran...


Girl Behind the Poem

Catherine "Gracie" Doran, 11, had to learn how to grow up pretty quickly.

Gracie, who suffered a stroke in the fifth grade, is now a sixth grader at Aliso Viejo Middle School. She is also a 2011 poster girl for the American Heart Association and the American Stroke Association’s Have a Heart, Save a Heart, campaign, which ended Feb 20. Today, Gracie has returned to full-function walking, though she has a limp and partial paralysis in her arm and hand. She is no longer paralyzed.

The AHA teamed up with Stater Bros. for the 10th year to raise awareness and funds to fight heart disease and stroke, the No. 1 and No. 3 killers in the United States.

Learning Early On

Gracie was diagnosed when she was 6 with cavernous hemangiomas. These are small, non-cancerous growths that were in found in her brain. She had a bleed in her brain (frontal lobe), and it caused a seizure. As a result, she was put on anti-seizure medications, said her mother, Barbara Doran.

“We were told she had numerous hemangiomas. We monitored them for many years with no issues. Then two years ago, one in particular on her brain stem was very troubling. We consulted numerous doctors and were told that is was too dangerous to remove it surgically. These things can be left alone and never cause any damage, and the odds of a brain bleed are very small,” she said.

A Life-Changing Moment

On Aug. 2, 2009, at age 10, while enjoying a day at the beach, things changed for Gracie.

“We took her home—not quite realizing that it was a stroke—and called her doctor,” Barbara Doran said.

The family was advised take Gracie to CHOC and after a CAT scan was performed, they found out the hemangioma had ruptured.  She now was showing signs of stroke damage—right-sided weakness, left-sided facial weakness and slurred speech.

Surgeons felt Gracie would need surgery to remove the blood clot and hemangioma tissue. But they wanted to wait a few days before performing the surgery. Gracie started to decline physically and underwent brain surgery in August 2009. Post-operatively, her entire body was paralyzed, and she could not eat, speak or move. Her blood clot was very large and left a lot of damage, said Barbara Doran.

“We stayed at CHOC another week and then were transferred to Healthbridge Children's Hospital for in-patient rehabilitation. She stayed there about seven weeks and re-learned to eat, speak and walk.  She still had to use a wheelchair for two months after she came home but is now walking without aid,” said Barbara Doran.

Gracie also has a limp, and her right hand is paralyzed. The left side of her face is paralyzed, but she has had facial nerve reconstruction.

Moving Forward

Doran said that her daughter's smile is now coming back and that she has had five eye surgeries and another brain surgery in November on her frontal lobe because another hemangioma started to look suspicious.

“I always thought that even though this happened to me, I would get better and I would do good things because of it,” said Gracie, who wants a career “helping others.”

“As a mom," Barbara Doran said, "it’s one of those situations where you just do what you need to do to take care of your family.  Gracie was a great source of strength with her sheer determination to get better. I figured if she didn't feel sorry for herself, I couldn't feel sorry for myself.  The support of my husband, other children, friends, church, the school and her dance family kept us all going.”

Gracie's siblings include Rachel, 25; Krista, 21; and 9-year-old brother Michael.

“Mentally, she is the strongest person I know,” said her mother. “She does not think of herself as sick or disabled and won't let anyone else think of her that way either.”

Still Learning, Still Coping

Cognitively, Gracie is at 100 percent. She's on the honor roll and was chosen to be in the CUSD honor choir last year only four months after she re-learned to speak.

Pre-surgery, she was a competitive dancer at Mission Viejo Dance and Performing Arts Center. The group worked it out so she could still be on the team even when she could barely walk. They made her a plant on a rolling cart, and she stole the show. This year, she is competing again on the production team.

“All of these things keep us and her going. She worked so hard and exceeded all expectations and time lines on her recovery,” said Barbara Doran. “She rarely gets down. I think I've cried more about this then she has."

Gracie became a campaign poster girl for Stater Bros. via a friend of the family who works for the American Heart Association.

“I was unaware that the AHA was also the American Stroke Association. We agreed immediately because we feel very strongly that we need to pay it forward,” said Barbara Doran. “We have been given so much support from the community and we felt if we can share our story and help raise money for such a great cause, we were happy to do it."

The family members continue to be proud of Gracie as they watch her grow and get stronger daily.

“Every one of us has been so greatly affected by what happened.  Gracie is an inspiration to many, and that makes us very proud. Her name says it all, as she has shown so much maturity and grace throughout this entire journey,” says Barbara Doran.

“Never give up, because even though something bad happens to you, good things will come back to you,” said Gracie.

Visit caringbridge.org/visit/catherinegracedoran and read Gracie's  blog.

Last year, Have a Heart, Save a Heart raised $413,310 by selling $1 and $5 hearts at registers in Stater Bros. stores throughout Southern California. Since 2001, Stater Bros. has raised more than $2.8 million for the fight against heart disease and stroke.

Original source http://lagunaniguel.patch.com/articles/the-grace-of-a-young-stroke-victim-is-an-inspiration

Dr. Slattery and Dr. Azizzadeh performed hypoglossal-facial nerve transfer on Joe Mare because he had suffered total facial paralysis due to the car accident.

March 5, 2011 by STEPHEN HAYNES / This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Two fastballs for strikes, a third one taken high for a ball. With the count 1-and-2, another four-seamer up in the zone. Joe Mare recognized the pitch, timed it . . . and whiffed.

And for those who know him, it was a wonderful sight.

That game - C.W. Post's 12-6 loss to Felician in North Carolina on Feb. 20 - and that at-bat, Mare said, with the Pioneers trailing by six in the ninth, were the most meaningful and fulfilling he's ever had.

That his concerns were "we went 0-4 on the road trip" and "my bat speed needs to improve" is a testament to how far the former star has come.
Three years ago on that date, after a car accident, he was comatose and the prognosis still was uncertain.
Mare, now 24, says he doesn't remember anything about the day or the incident - just morsels of information pieced together from police reports and others' accounts.

At about 2:30 a.m. Feb. 10, 2008, the Whitestone native was struck by a car while crossing Francis Lewis Boulevard. Mare's father, Tom, said the driver - who wasn't charged - called 911, and Mare was rushed to New York Hospital in Queens. There, relatives said, doctors discovered a fractured skull, cranial hematoma, brain trauma, a collapsed lung and broken bones that included an orbital socket, an elbow, and tibia and fibula in both legs.

"When I first saw him, I was in a trance," said Mare's brother, Steve, 20. "It didn't even look like him. He was all bloody and his face was blue."
His mother, Nancy, recalls looking to an EMT for assurance, "and he looked down and shook his head."

An operating room nurse had given Joe "about a 20-percent chance to live," she said.

Severe loss of memory

Mare remained unconscious for almost a month. In late February, he was transferred to the traumatic brain injuries unit of Jamaica Hospital, where he stayed until he was released May 2.

Upon awakening, Mare said, he immediately recognized close relatives - but every memory, every detail of his life, had been deleted. What he knows now about his past comes mostly from stories and photos. The awards in his bedroom are what tipped him off about his baseball career.
But some things, perhaps, are intrinsic.

"The smell of the field, the feeling of warming up, sitting in the dugout," Mare said of his return to the diamond last month. "It almost feels like I never left because those feelings seemed familiar."

Mare gauges himself at "about 70 percent" and admits his skills aren't close to where they were. He's now a backup infielder who'll get occasional playing time.

Top stats and honors

Three years ago, however, he was the team's No. 3 hitter, the face of the program, featured prominently on the cover of Post's athletic brochure. As a junior, he batted a team-high .402, led the team with six homers and 51 RBIs, and set the Pioneers' single-season record with 82 hits.

He was an honorable mention All-American and was selected to the All-Region first team.

The third baseman even had drawn some big-league interest, his father said. Mets and Brewers scouts planned to give him a look in spring 2008. "Ooh, I was that close!" Mare said.

Now the baseball stardom days are gone; he knows of his own achievements the same way he does Honus Wagner's: through statistics and stories of his feats.
"I don't expect to ever get them back," he said of the things forgotten, "so I'll have to create new memories."

Mare now is a graduate student working toward a master's degree in counseling. He works as a guidance counselor at Holy Cross, his old high school, for college credit.

His speech still is a bit slurred, and only in the last month has he been able to run without pain after having re-learned how to walk. The recovery, as arduous as it has been, is "remarkable," his mother said.

He says he has had 20 surgeries, including three brain operations, a tracheotomy, the insertion of metal rods in his legs and screws in his ankles, two eye surgeries and a nerve transplant that restored his ability to smile. Add to that countless hours of physical and speech therapy.

"If I had any idea what it would take when I got out of the hospital," Mare said, "I don't know if I would've wanted to try."

Nevertheless, he returned to school in the fall of 2008 - although he was "still kind of in a fog" - and graduated with a psychology degree in 2009.
Still, baseball beckoned.

"Hearing about the things I did," he said, "it was everything. Baseball was my identity . . . I didn't want the accident to beat me and completely take that away."

Dogged determination

Mare tried to make the team in 2010 but was too far off physically. Coach Pete Timmes "feared for his safety." That, of course, made him even more determined to come back and exhaust that last year of NCAA eligibility.

"He's up at 7 working out every morning," Steve Mare said. "The therapists can only do so much for you . . . If he hadn't wanted to play again, I don't think he would've pushed himself as hard."

So the last year has been spent training, in addition to his continued rehabilitation. Mare worked with a running coach, jogs 11/2 miles each day and hits the gym five times a week. Last autumn, he started weekend batting-practice sessions with his high school baseball coach, Doug Manfredonia, whom he remembered.

Mare doesn't remember his old swing, so he's been taught a new one. "Coach gave him a more compact stroke instead of that uppercut he used to have," his father joked.

So, three years later, an 0-for-1 in North Carolina? "It was a special moment," teammate Bo Budkevics said - one with such meaning, Timmes added, that it was "hard to put into words."

"I had my doubts, but then to see him in a uniform again, in a batter's box again," Steve Mare said. He paused and shook his head. "Who else but Joe, man?"

House-Brackmann Grading System and Facial Paralysis

There have been significant advances made in the understanding and treatment of facial paralysis in recent years. Thanks to continued research and testing being conducted in the medical community, facial reconstruction specialists today are not only able to determine the cause of the facial paralysis, but are also able to determine which muscles and nerves have been affected and to what degree. Knowing precisely which nerves and muscles are affected is very important in tailoring a treatment plan or procedure to restore a patient’s facial animation.

Treatment for facial paralysis can vary greatly, depending on a number of factors. The degree of paralysis, the cause of the paralysis and the length of the paralysis are just some of the things professionals take into consideration when discussing available treatment options with their patients. One of the most important tools in a facial reconstruction surgeon’s toolbox is the House-Brackmann grading system. The system is a six point scale that grades the severity of facial nerve impairment. It was adopted by the American Academy of Otolaryngology-Head and Neck Surgery in 1985 as the universal standard for measuring facial nerve impairment. Patients are examined to determine their level of impairment by measuring symptoms to one of the six levels on the scale. A level one is indicative of normal facial nerve function without limitations while a level six indicates complete paralysis and loss of nerve function.

Some facial paralysis is temporary, such as the symptoms found on the lower levels of the scale, and doesn’t require any treatment. Other forms of facial paralysis may be corrected by less invasive means than facial reconstructive surgery. The most severe cases of facial paralysis often require an in-depth procedure known as a gracilis free flap, which transplants muscles and nerves from the thigh into the face to replace the damaged facial nerve that is causing the impairment. By comparing a patient’s symptoms to the six levels on the House-Brackmann grading system, Dr. Azizzadeh is able to create a treatment plan that is tailored to meet the specific needs of each patient based on their personal level of impairment.

The Facial Paralysis Institute is one of the pioneering centers dedicated to the wellbeing of individuals suffering from facial nerve disorders.  The Institute is lead by Dr Babak Azizzadeh, one of the top facial plastic surgeons and facial paralysis experts in the country.

If you or a loved one is suffering with facial paralysis, schedule a consultation at The Facial Paralysis Institute with Dr. Azizzadeh today to discuss the available treatment options and find out which option the House-Brackmann grading system suggests might be best choice to improve the effects that facial paralysis has in your life.

The Causes of Bell's Palsy

If there is one thing that you should know about Bell's Palsy it is that, in fact, there are no known definite causes of the condition. Bell's Palsy is the name given to facial paralysis that has no identifiable cause, and it is therefore quite difficult to pin-down and understand.

It is thought that Bell's Palsy is probably caused by a viral infection of the seventh cranial nerve (the nerve that serves much of the face, controlling expression and taste). Other theories suggest it could be the herpes zoster or herpes simplex virus causing the problem, and even when someone suffers the main symptoms of this kind of infection, it can stay in the nerve for years. Then, when something triggers it the nerve becomes inflamed and facial paralysis occurs.

Instead of concentrating on what we don't know about Bell's Palsy, we at the Facial Paralysis Institute like to concentrate on what we do know, and what we can do with that knowledge. Bell's Palsy is caused by a dysfunctioning seventh cranial nerve, and the fact that it's most likely caused by a viral infection means that we can treat it early with anti-viral drugsand steroids.  If you've got eczema then you'll know that putting steroid cream on the skin reduces the inflammation; oral steroids act in a similar way on nerves, too.

Early surgical intervention can be considered when Bell's Palsy becomes a permanent condition. This happens when the inflammation has been present for too long and the nerve has been damaged. Surgery is also particularly beneficial when Bell's Palsy is caused by a severely trapped or compressed seventh cranial nerve. In this case the surgeon can relieve the pressure, and the nerve is able to send messages to-and-from the brain again. Physiotherapy, Botox, and neuromuscular retraining are two treatments that compliment surgery on Bell's Palsy patients who have not had full recovery of facial movements.

Of course it would be fantastic to know for certain what the exact causes of Bell's Palsy are, but for now we are grateful that we have the resources to treat it and allow sufferers a pathway back to their normal life with full expressions and a social life.

If you're unfamiliar with surgery to treat Bell's Palsy, why not watch our video on how Dr. Babak Aizzadeh helped Mary-Jo Butafuocco overcome her facial paralysis following a gunshot wound: http://www.facialparalysisinstitute.com/MaryStory.html. This may be an extreme case, but it shows how simple it is to regain facial expression and normality after suffering the permanent effects of Bell's Palsy.

Facial Paralysis in the Media

If you've spent a certain amount of time on the Facial Paralysis Institute's website, then you may have seen the work that Dr. Azizzadeh, Director of the Institute, carried out for Mary Jo Buttafuoco on the Oprah Winfrey show.  You can read about and see Mary Jo's transformation here: http://www.facialparalysisinstitute.com/MaryStory.html.

Yet what about facial paralysis and Bells Palsy in the rest of the media? Many people are unsure of what Bells Palsy actually is, and up until the past four or five years facial paralysis had not had all that much mainstream focus.

What we're really glad to see are instances of people's facial paralysis experiences being reported in newspapers and on television. Take, for instance, the recent report in the New York Times blog (http://cityroom.blogs.nytimes.com/2010/06/17/lyme-disease-cases-up-sharply/) on how the number of Lyme Disease cases are on the rise, and as one of the commenters points out - a warning sign is the onset of facial paralysis. If something as simple as that alerts one person then it's worth it - but thousands read the blog, so it's more than worthwhile. So, if you have suffered from facial paralysis we urge you not to stay silent about your experience. The key to recovery is to catch the condition and treat it quickly, so if your story can raise awareness then why not blog about it, or write to your favorite magazine who might print the story?

Bells Palsy and facial paralysis are not conditions that are unheard of anymore, but even still, we would like to see that everyone in the US knows what they are and what the warning signs of an episode may be. The principle is so simple: you have a lack of control over your facial muscles, you go to your doctor ASAP. Hopefully with this kind of initiative a number of people will see a difference between recovery in three months, rather than twelve.  Early treatment can reduce the risk of long-term deformity.

The Social Impacts of Facial Paralysis

Facial paralysis and Bell's Palsy both have a number of emotional and physical effects, such as anxiety over the sudden lack of control, and depression from feeling helpless.

One of the major impacts that facial paralysis has on a person's life is their ability to interact with others socially. One recent article on SunSentinel.com 'How Can You Express Emotion When You Have Facial Paralysis?' (http://articles.sun-sentinel.com/2010-04-07/news/sfl-facial-expressions-040710_1_expressions-social-worker-david-matsumoto) takes a look at a social worker in Los Angeles who cannot connect with the people she worked with because she suffered from Moebius syndrome - a congenital condition that causes facial paralysis.

So much of human interaction relies on facial expressions, and yet incredibly we often don't realize just how much until it's gone. In SunSentinel.com's article, writer Benedict Carey explains that we naturally mimic the expressions of the people we're talking to, in order to empathize with them and show our understanding. Those who can't mimic those expressions come across as cold, and despite what they might say to ensure someone they understand, it's difficult to accept that they do.

Many of those suffering with facial paralysis rely on body language to express the emotions that can't be expressed through words and should be expressed through facial expressions. Nods and shakes of the head, the position of the arms and legs and gesticulating with the hands can do a lot. People who are talking to someone with facial paralysis need to be taught to look at body language to get their subtle social clues and aid interaction, but unfortunately this is not common knowledge.  

Because facial paralysis has such serious implications for a sufferer's mental health as well as their physical health, it's of paramount importance that we raise awareness of the conditions, and find ways for these individuals to cope and function well in social situations. Here at the Facial Paralysis Institute we are all about raising awareness, so if you can tweet a link to this article, or email it to your contacts and it's read by just one person, you could make a world of difference to someone with the condition.

Bell's Palsy Treatment Options

Welcome to the Facial Paralysis Institute Blog! Here you'll find out about any updates, new procedures and new findings in Bell's Palsy and facial paralysis treatment, as well as gain an insight into the FPI's surgery center, the staff that work here and what we aim to do for our patients.

If you're unfamiliar with any of the conditions we treat here, please take a look at the sections of our site, found at the top of each page. Our Harvard and UCLA trained surgeons and physicians specialize in Otolaryngology, Bell's Palsy and facial paralysis treatment, as well as facial plastic and reconstructive surgery and nerve transplants.

We're starting off our blog today with information on Bell's Palsy Surgical treatment, as it's an important area for many of our patients.

Firstly it's important to remember that facial paralysis and Bell's Palsy are not one and the same. Bell's Palsy is a sub-condition of the more general term 'facial paralysis' and it is used to describe patients who experience facial paralysis but with no or little known cause. It's thought that viral infection of the cranio-facial nerve may often be the cause of Bell's Palsy, but there is no easy way to prove this.  

Secondly, we are keen to stress that Bell's Palsy surgery treatment is not a first port of call for our trained and experienced physicians, as in many cases it is not needed. Treatments such as physiotherapy, along with anaesthetic nerve blocks, strong antiviral medications and courses of corticosteroids can be of great help to many sufferers of Bell's Palsy, providing the condition is caught and treated early.

Surgery is reserved for patients who have suffered heavy nerve damage, whereby other methods of treatment may be futile. To determine the extent of nerve damage, our physicians now use ENoG (Electro Neuronography) to investigate, and if 95% of nerve damage is found, then surgery may be considered in the first few weeks after the onset of Bell's Palsy.

The Bell's Palsy surgical procedure is also known as 'Facial Nerve Decompression', where the nerve is opened and the protective sheath released. If the nerve has been compressed, or is swollen then the protective sheath will be compacting it and preventing adequate information to pass between the brain and the facial muscles. Allowing this nerve to decompress can give some control back to the patient in extreme cases, and where other forms of medical treatment have already been sought. Under no circumstances will a patient be offered surgery for Bell's Palsy straight away - they will need to have various tests to rule out other causes, and their physician will need to try any other (less invasive) treatment that could possibly help.

Often the full benefits of facial nerve decompression aren't seen until 8 to 12 months following the surgery, so patients should be aware that they will not regain facial muscle tone or movement straight away.  

Hopefully we've gone some way to explaining more about the Bell's Palsy condition, and the possible treatments that there are for it. Please subscribe to our RSS feed to keep up to date with any news in the field, and further blog entries on Bell's Palsy and facial paralysis.