What is Facial Paralysis Surgery?

Facial Paralysis (or Bells’s Palsy) Surgery refers to a complex surgical procedure that provides motion to the face of a patient who has suffered facial paralysis. The desired changes of the face can be achieved either just after one highly specialized operation or through multiple procedures.  In certain case,s by using microsurgical techniques, a muscle from the inner thigh is transplanted to the affected side of the face which reconnects the nerves and blood vessels giving a new life to the face.

The story of each face is different and hence Bell’s Palsy treatment requires a specialized and customized plan based on the needs of the patient. In order to attain this, the surgeons suggest a sequence of the surgical stages.

What is Facial Paralysis and  What Are Its Causes?

Facial Paralysis refers to a situation where nerve damage occurs due to sudden trauma or other medical conditions, such as Bell’s palsy, which leads to an inability to move the muscles of the face, on one side of the face or both. A patient suffering from facial paralysis will find it difficult to speak, blink, swallow or even smile.

The facial nerve belongs to the category of seventh cranial nerves which innervates and modulates the muscles of facial expression. There are five main branches:

  • Cervical

  • Marginal mandibular

  • Buccal

  • Zygomatic

  • Frontal

Each category innervates specific facial muscle regulating functions like expansion and contraction, the Buccal and Zygomatic branches have the greatest importance functionally as they innervate the muscles that control oral capability like preventing drooling, voluntary closure and opening of the eye, and smiling.

The primary causes of facial nerve paralysis include

  • Congenital deformities (like Mobius syndrome)

  • Acquired defects such as tumor resection

  • Bell’s palsy or trauma

Surgical Procedures Involved In Facial Paralysis Treatment

There are a number of surgical procedures that can restore the movement of the lower part of the face. Some of these surgical procedures involve moving the facial nerves, tendons, and muscles or their parts from other areas of the body to the face.

Surgery to transplant muscle tissue of the face, however, may involve more than one procedure and this might require hospital stays at each stage. A Facial Paralysis Surgery may include any of the following process:-

Temporalis Tendon Transfer Procedure (T3): This is the simplest of all the procedures of facial paralysis surgery that moves the temporalis muscle and tendon from one location in the face to another.

Gracilis Muscle Transplant (Gracilis Free Flap): In this process, the surgeon transfers a small portion of the thin muscle of the inner thigh to replace facial muscles.

Cross-Facial Nerve Grafting: Under this procedure, the surgeon moves the facial nerves from one side to the other side of the face to enable that part to contract and expand like a normal face.

Masseteric Muscle Transfer: In this technique of the facial surgery the facial muscle that helps in chewing is re-routed to a new area in the face.

Hypoglossal Nerve Transfer: It is another procedure of nerve transfer where the surgeon relocates a portion of the facial nerve that helps in moving the tongue to a position that enables a transplanted muscle to function.

Difference between Static and Dynamic Procedures

There are some patients of Bell’s palsy who are unable to control their mouth. Such patients not only face difficulties in smiling but also they cannot control drooling, chewing or eating food. The lack of flexibility of the eye muscles leads to heavy eyelid tone, causing drooping of the lower eyelid as well as excessive eye dryness. Eye dryness can be very irritating at times and it has adverse effects on vision as well.

Bell’s Palsy treatment options for such patients are generally categorized as static or dynamic reconstructions. Static treatment procedures such as facial suspends do not restore facial movement. Static treatment involves suspensory surgeries that hold the corners of the mouth in position and improve the capability of the lower eyelid by enhancing its opening and closure functions.

A dynamic procedure, on the other hand, involves replacing lost mobility of the facial muscles with an innervated muscle usually from the inner thigh known as Gracilis muscle. However, patients who undergo facial paralysis surgery under dynamic procedures not only improve the inactiveness of their mouth and face but can also move their facial parts voluntarily and smile to their heart’s content. In minors, dynamic facial paralysis treatment is preferred, due to its better outcomes.

Postoperative Care after Facial Paralysis Surgery

Usually, a patient undergoing facial paralysis treatment is able to resume their day to day normal activities anytime between two to three weeks after the surgery.  However, patients should get fully active or start exercising only after a month of surgery. After recovery, your consultant surgeon will refer you to a physiotherapist to initiate facial training, biofeedback and self-facial exercises to facilitate the return of your facial expressions. Often, secondary outpatient refinement surgery is necessary at 3-4 months to make minor cosmetic adjustments.  Following are some postoperative care tips after Facial Paralysis Surgery:-

  • The patient must try to get up, move around the house, and take some deep breaths 4-6 times a day.

  • The patient must try to sleep on back and if possible keep the head elevated.

  • Avoid sleeping sideways as it might cause swelling on the side the patient is laying on. Helping self with a pillows nest can be very helpful.

  • Some patients might experience a slight sore throat or mild cough for 2-3 days after surgery takes place. This happens as a side effect of anesthesia and it should be cured within 48-72 hours.

Bell’s Palsy Treatment in Hyderabad

KIMS hospital in Hyderabad is one of the best plastic surgery hospitals for facial paralysis surgery. Dr. Sharath Chandra Reddy and his team of plastic surgeons at KIMS hospital Hyderabad have decades of combined experience in all kinds of plastic and cosmetic surgery. Please fill out the form below to book your appointment now with Dr. Sharath to discuss Bell’s Palsy treatment options and understand the possible course of action.