Facial nerve palsy, also known as facial nerve paralysis, refers to various forms of facial paralysis. Those affected are often unable to consciously control their facial muscles, often on one side. However, good patient satisfaction can be achieved through a variety of possible surgical interventions. As reconstructive procedures, the costs of treatment are generally covered by health insurance.
Here you will find further information as well as selected facial palsy specialists and centers.
Facial nerve palsy, also known as facial nerve paralysis, is a very stigmatizing condition for those affected. They are unable to control their facial muscles properly. As a result, their facial expression appears inappropriate or conspicuous to other people. In most cases, only one side of the face is affected.
The cause of facial nerve palsy is the 7th cranial nerve(facial nerve). It is primarily responsible for the mimic muscles. It also influences the secretion of tears and saliva as well as the perception of taste.
A variety of causes can lead to damage to the nerve with a reduction or loss of function. The most common is so-called idiopathic facial nerve palsy (Bell's palsy), which only affects one side of the face. No cause can be found for this. In most cases, this form of facial nerve palsy regresses spontaneously.
Other causes include
Facial nerve palsy occurs in around 20-30 per 100,000 people per year. A cause cannot be identified in 80 percent of cases.
A functional restriction/loss of the facial nerve can result in the following symptoms, depending on the location:
Woman with Bell's palsy facial paralysis © Jo Ann Snover | AdobeStock
A distinction is made between
In the central type of paralysis, the mimic muscles of the mouth are primarily affected. In contrast to peripheral paralysis, the patient is still able to frown.
A thorough clinical and electrophysiological examination of the patient is carried out in interdisciplinary cooperation. This includes test procedures such as
are used. The aim is to determine the cause, localization and severity of facial nerve palsy. Any residual function of the facial nerve is also of interest.
In individual cases, further special examinations are carried out using computer tomography (CT) and magnetic resonance imaging (MRI).
An individual treatment plan is then developed together with the patient.
As soon as it can be assumed that the paralysis will not continue to improve spontaneously, surgical treatment is necessary.
Depending on the cause and severity of the condition, various surgical procedures are available. These include
Due to the variety of possible surgical procedures, it is difficult to make a uniform statement regarding the choice of anesthesia.
Complex facial procedures are almost exclusively performed under general anesthesia . They include free muscle grafts for dynamic reconstruction of the corner of the mouth. The inpatient stay can then last 7-10 days.
Smaller corrective procedures can also be performed as outpatient procedures, sometimes under local anesthesia.
The choice of method depends largely on
patient's wishes. The surgeon and patient must decide on the procedure of choice together.
In principle, a distinction can be made between
can be distinguished.
After an injury, immediate treatment offers the best prospects for successful reinnervation.
This requires skin nerves that are responsible for sensation. The sural nerve from the lower leg, for example, is suitable for this. Defects in the course of the facial nerve can thus be successfully bridged.
Parts of the hypoglossal nerve (lingual nerve) are connected to the peripheral ends of the facial nerve. In this way, doctors achieve reinnervation of the paralyzed muscles.
The disadvantage of this procedure is the occurrence of so-called "synkinesia", i.e. the occurrence of involuntary muscle movements.
A suitable central facial nerve stump is not always available. In this case, a nerve graft from the calf is an option. This allows doctors to achieve the innervation of the muscles on the paralyzed side from the healthy side.
The CFNG can also serve as a connecting nerve for a free muscle transplant. To connect the CFNG, a smaller facial branch must be used on the healthy side.
Due to the redundancy of the nerve in the supply area, there are no functional restrictions on the healthy side. In this context, redundancy means that the same function is triggered by several nerve branches.
It is also possible to insert an innervated masticatory muscle into the paralyzed mimic musculature, e.g. by repositioning. The temporal muscle or the masseter muscle are particularly suitable for this. They are supplied by an unaffected cranial nerve, the trigeminal nerve.
Free neurovascular functional muscle transplantation is also part of the routine repertoire of specialized centers. This involves the use of a free muscle-nerve-vascular graft to replace the paralyzed facial muscles. A part of the thighmuscle (gracilis muscle) or back muscle(latissimus dorsi muscle) could be used, for example
The complete vascular supply and nerve supply to the muscle in the face must be restored. This requires a microsurgical procedure lasting several hours.
Such an operation achieves the best results, as a dynamic reconstruction of the smile is possible. The vector (the direction of traction) of the muscle in the face can thus be freely selected. This means that the desired result can be best adapted to the opposite side.
The donor nerve is either
In some cases, static reins using tendon strips (usually taken from the thigh) may be necessary. This merely restores the symmetry of the face. Dynamic movement of the corner of the mouth, e.g. for smiling, cannot be achieved in this way.
This can be a satisfactory option, especially for patients of advanced age who do not require maximum treatment.
Static retraction surgery, possibly with implantation of an upper eyelid weight: In many cases, tightening of the eyelid frenulum on the lower eyelid is already sufficient to achieve eye closure.
If necessary, weights can also be implanted in the upper eyelid, e.g. made of gold or platinum. Gravity then helps to close the eyes completely.
Some patients would like to be able to voluntarily squint their eyes again. In this case, they require a dynamic restoration of eye closure.
Muscle repositioning procedures are suitable for this. For example, part of a temporal muscle can be repositioned in such a way that in the first few months biting leads to eye closure.
This mechanism usually takes on a life of its own within a few months. It is then possible to close the eye without biting.
Special follow-up treatment is not usually necessary. Drains inserted intraoperatively to drain the wound water are removed during the inpatient stay. The sutures are removed after 10-12 days.
For procedures based on nerve regeneration (CFNG, free muscle grafting), a regeneration period of several months is to be expected. Only then will the first muscle activity be visible.
Post-operative facial exercises may also support the regeneration process.
No operation can completely restore facial expressions or functionality. Nevertheless, good results can be achieved, which mean a significant improvement for the often stigmatized patients.
However, the sometimes highly complex, lengthy surgical procedures also involve risks. As with any operation, there is a risk of secondary bleeding or infection. However, these can be controlled.
The more complex the procedure, the higher the risk that the result will not be satisfactory .
For example, nerve regeneration may not occur during nerve transplantation. In the case of free muscle transplantation, the muscle may be lost due to circulatory disorders. With CFNG, nerve fibers on the healthy side of the face can also be damaged.
However, these complications are generally rare. In the absence of success, they also leave options for further alternative procedures.
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