A peripheral facial palsy (facial muscle paresis) in most cases affects one side of the face, and can develop after removal of tumors of the parotid gland, the inner ear or the facial nerve itself, but also without known cause (idiopathic). In rare cases, such as congenital facial palsy, both sides of the face can be affected.
The potential of an operative therapy depends on various factors, including the age of the patient, the length of time since the onset of the paralysis and the prospect of regeneration. The eligibility for surgical treatment should be determined during an individual counseling interview.
In principle, there is the option of a static or a dynamic reconstruction:
During static reconstruction, surgical corrections of the skin and perhaps also the muscular layer of the face are performed, such as lifting of the sunken eyebrow, tightening of the facial skin in front of the ear, or raising the corner of the mouth and deepening the nasolabial fold. This serves to symmetrize the face, but does not replace motor function.
Dynamic reconstruction aims to achieve a reanimation of the palsied side of the face, for instance when the patient laughs. For this, a first step involves connecting a cutaneous nerve from the lower leg and linking it to the healthy side. After eight to ten months, nerve fibers will have grown from the healthy side to the paralyzed side, so that during a second operation a muscle harvested from the thigh (functional transfer of gracilis m.) can be connected through microneurovascular technique. This will assume its function about three to six months after the operation. To this end, intensive physical therapy support is required. By coupling of the nerve responsible for movement of the mouth on the contralateral side a coordinated smile can be achieved. In dynamic reconstruction, another possible procedure is the transfer of a muscle from the temple to the superior and inferior lid, so that after reeducation the eye can be actively shut (temporalis transfer).
In the case of incomplete and partially regenerated facial palsy the injection of botulinum toxin A offers a good chance to restore symmetry to facial motor function. This also makes possible the attenuation of hyperactive muscular movements or accompanying movements (synkinesias).
We provide interdisciplinary care in the context of a special consultation (facialis consultation) attended by both a neurologist as well as the physical therapy team.