Facial Paralysis and Facial Reanimation: Johns Hopkins | Q&A

Facial Paralysis and Facial Reanimation: Johns Hopkins | Q&A


[MUSIC] The facial nerve, which is number seven
of the cranial nerves. Controls all of the muscles
of facial expression, so this one nerve controls
our ability to blink, to lift our eyebrows, to smile
or frown to express emotion. There are a variety of
causes of facial paralysis, the common ones we see
are acoustic neuromas, these are benign tumors
of the hearing nerve. Bells palsy, that’s a very common cause
of facial paralysis, which often leaves people
with incomplete paralysis. Tumors of the proractic gland,
and traumatic injuries. Sometimes people
get into accidents, and this can affect their
facial nerve as well. The last main category we
see is congenital cases. So occasionally babies are born
with an inability to move one or both sides of their face. We can restore movement to the
face in a few different ways. In cases of early paralysis. So cases in which the paralysis
has not been present too long, say less than a year. Then we can often restore
movement through nerve transfer techniques. So in that situation
we can take a nerve that’s intended to do one
thing and repurpose it. A real common example is
a masseteric nerve transfer. The masseteric nerve is a nerve
in our face that helps us chew. And we’ll often
reroute this nerve using microsurgical techniques. We’ll take the masseteric nerve
for chewing and we’ll repurpose it and connect it to one or more
branches of the facial nerve. And then the patient can
relearn how to smile by activating that nerve. In other cases, instead of reintervating
the natural facial muscles, what we’ll do is we’ll provide an
alternative source of movement. And that really falls
into two categories, one is a gracilis free
muscle transplant. So the grisseles a muscle
that we take from the leg and that can be used to
restore movement. And another is a temporalis
tendon transfer, that involves taking
a muscle that is intended to help us chew and
we repurpose the muscle. We reroute it to allow
it to restore a smile. [MUSIC] The timing of facial reanimation
procedures really depends on each individual’s situation. In general,
you can think of it like this. There’s a window period
after an initial injury. So it could be
an acoustic neuroma, it could be a tumor,
or a trauma. But for a period of time when the facial
nerve has been injured, the muscles of facial expression
are still salvageable. So, we consider this a really
important window of time, because if we can intervene
early and time it well, we can save the natural muscles
of expression and regenerate that ability to show expression,
and to smile, and to blink. In other cases though,
that window period is lost. And the paralysis
has been present so long that it’s too late. What happens is that the muscles
gets fibrosed and they atrophy. And they just can’t
move anymore. The good news for patients
is that even in cases of long standing paralysis
of many many years. There’s still a variety of
techniques that are extremely effective that we can
restore the ability to smile. We can restore the ability
to protect the eye. But, in those cases
we can wait longer, there’s no particular rush. [MUSIC] A really important aspect of
facial paralysis is the fact that the paralysis prevents
patients from being able to blink normally. And so one of our early
areas to really focus on is helping people
protect their eye. And there is a variety of
techniques we have there as well. One of the more common
ones is to place a little platinum chain, it’s a weight
that’s implanted unobtrusively, it’s small, into the upper
eyelid and it allows the patient to passively relax their eye and
it can therefore close and protect the eye and
distribute the tear film. In other cases we’ll help
restore a better visual fields to improve the vision by
re-positioning the eyebrow if it’s drooping, by lifting the
lower eyelid if it’s drooping. So that a lot of our focus early
on is really on helping restore function and
appearance to the eye. [MUSIC] John’s Hopkins is
a terrific place for patients with facial paralysis
for two really specific reasons. Experience, and expertise. Since I became division director
of facial plastic surgery in 2001, we’ve treated over a 1,000
patients with facial paralysis. This makes us easily one of the
busiest centers in the country, if not the world. So it’s really hard to find
surgeons who have that type of experience and we’re very
fortunate here to have that. But the other is expertise. My practice for
example is highly focused, it’s microsurgery and
facial aesthetic surgery. In all these years now
approaching 15 years of spending countless hours doing facelift
and eyelid surgery and brow surgery and
injecting filler and using injectables to restore and
change movement. For patients who have a very
discerning approach and really expect, perfect outcomes. That combination of skills and
microsurgery and facial aesthetic surgery I have
found is extraordinarily helpful to patients with
facial paralysis. The people with
facial paralysis, they want to look normal and in many cases they want to
look beautiful as well. And so what we try to do
is open up the box and use whatever techniques
we have available, and employ them all in
any given case. So, sometimes that means focus
procedures to restore a smile, but often means we do
procedures at the same time, and we’ll do what we can to
help restore a more beautiful, normal, apeiron face. What also is unique about our
approach to facial paralysis is that we have a true
team approach. So in our division there
are three full time surgeons. Each of us focuses on
facial paralysis treatment. We also have a very
comprehensive program focused on outcomes in facial paralysis. So we’re very unique
in that regard. And then we have a whole
complement of other team members. Speech therapists, Neurologists who do facial
motor testing for us. And Facial retraining expert. This is a physical therapist
who has dedicated her career to patients with
facial paralysis. This combination of
services all under one roof makes us highly unique. But we really believe that
a team approach to facial paralysis is the best way to go. [MUSIC]

4 Comments

  • Recht Spraak says:

    Fuck that !!! Cannabis is the cure for facial paralysis !!!!!! Mine was worse. I was two years treated by neurologists without any result. By using cannabis, I was completely healed within weeks !!!!!!!!!!!!!!! Use the oil or smoke it pure, without mixing it !!!!!!!1

  • Art M says:

    I had a parotid gland malignant tumor that had to be removed urgently. In the surgery, they also removed the saliva gland, facial nerves, jaw bone and some lymph nodes. The surgery took place on 7/11/18 and till this day, I’m not able to fully open my mouth and fully blink my eye or raise my eyebrow despite having had nerve graph. Can you help me recover my smile and fully open my mouth because I bite my lips every time eat.

  • Joe Dawood says:

    I cut my facial nerve 24 years ago, did electric therapy, it got worse, I never tried anything until 4 years ago (Botox) and it didn’t work well as it froze or gave me different movements. I feel like when they reconnected the nerve, it was all wrong at that time. Any suggestions?

  • Shannon Agapay says:

    Could you recommend a facility on the west coast? I live in Hawaii and I have facial paralysis

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