|
The facial nerve controls the movement and expression of the facial muscles. Facial nerve paralysis is physically, aesthetically and emotionally devastating to an individual. Extensive experience and training is required to treat patients with these disorders.Bells Palsy surgeon Dr. Azizzadeh has spent an extensive amount of time training at Harvard Medical School under the guidance of Dr. Mack Cheney, one of the world's leading experts in facial nerve paralysis. Dr. Azizzadeh is trained in FACIAL PLASTIC & RECONSTRUCTIVE SURGERY as well as Head & Neck Surgery which gives him a distinctive insight into facial nerve function and facial aesthetics. Furthermore, Dr. Azizzadeh has extensively trained in microsurgical facial reconstruction which is often required for the treatment of children and adults who are born with facial paralysis.
There are numerous causes of facial nerve paralysis:
- Bell's palsy
- Trauma
- Acoustic neuroma surgery
- Ear and parotid surgery
- Congenital (Mobius)
- Stroke and other central nervous system disorder
- Herpes Zoster Oticus
- Melkersson-Rosenthal Syndrome
- Hemifacial microsomia
- Middle ear infections
- Lyme disease
The factors that are most important in the medical and surgical management of patients with facial nerve paralysis are:
- Etiology of paralysis
- Degree of paralysis
- Duration of paralysis
- Patient's age
- Patient's state of health
- Patient's desires
Functional and aesthetic impairments associated with facial nerve paralysis include:
- Facial asymmetry
- Depression of brows
- Inability to close the eyelids (Lagophthalmos)
- Paralysis of lower eyelid (ectropion)
- Decreased tear production
- Corneal damage
- Mid-face drooping
- Effacement and nasolabial fold ("laugh line")
- Nasal airway obstruction secondary external valve collapse
- Inability to smile (asymmetry)
- Oral incompetence and drooling
- Lower lip deficit
The most important treatment objective for individuals with facial paralysis is prevention of unwanted eye complications, restoration and reconstruction of facial movement, restoration of a dynamic smile, and improvement of facial aesthetics. Dr. Azizzadeh and his team of otolaryngologists, head & neck surgeons, ophthalmologists and physical therapists utilize a systematic approach to reach these objectives. Three regions of the face are addressed:
- Brow and eyelid region
a. Gold weight placement to help upper eyelid closure
b. Surgical tightening of the lower eyelid
c. Endoscopic brow lift to improve eye brow position and symmetry
- Smile and mid-face region
a. Creation of dynamic smile (most important goal)
b. Facelift procedure to improve symmetry and aesthetics of the face
c. Subperiosteal midface lift (midface drooping)
d. Creation of nasolabial fold ("laugh line") utilizing suture techniques
e. Static suspension of nasal ala to improve nasal breathing
f. "touch-up" procedures
- Lower face and lips
a. Lower lip wedge excision
b. Asymmetric facelift
c. Dynamic lip depressor rehabilitation
Finally, Physical therapy is an indispensable tool for getting the most out of facial paralysis reconstruction. The commitment to undergo long-term physical therapy is a pre-requisite for any patient desiring significant improvement in facial function and appearance. Please contact Dr. Azizzadeh if you or your family have any further questions or desire to be seen in consultation for Bells Palsy.
|
