Bell's Palsy

Questions to Ask Your Doctor about Bell's Palsy
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Surgery

The role of surgery as a therapy for Bell's palsy is controversial. If patients do not completely recover, surgical treatment may be indicated. These complex procedures are performed on the facial nerves and muscles in order to reduce distortion of facial features and help restore function (e.g., eye closure).

The three main procedures are facial nerve repair and nerve graft, nerve substitution, and muscle transposition. These procedures are not able to completely restore normal function, but they can significantly improve facial function and appearance.

Facial nerve repair is the most effective procedure to restore facial function in patients who have suffered nerve damage from an accident or during surgery. It involves microscopic repair of a nerve that has been cut. A nerve graft replaces one that has been removed.

Nerve substitution is indicated when the nerve cannot be repaired in the conventional manner. In this procedure, another cranial nerve involved in facial movement is connected to the damaged nerve and takes over its function.

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Muscle transposition is used in patients who have had facial paralysis for at least 2 years and are unlikely candidates for nerve repair or substitution. This procedure involves the transfer of a muscle with its original nerve supply (a neuromuscular unit) to the affected area. The temporalis muscle or masseter muscle (two muscles in the face that are not controlled by the facial nerve) are moved and connected to the corner of the mouth to provide movement in the lower part of the face. In free muscle transfer, muscles from the leg are moved to the face to provide bulk and function.

In addition to these procedures, a brow or facelift may be necessary to reduce facial drooping. The lower eyelid, which may begin to droop and turn outward (called ectropion) because of the lack of muscle tone, can be tightened with corrective surgery. Weights can be implanted into the eyelid to help the eye blink and close.

Surgical removal of the bone near the nerve, known as decompression surgery, is performed in severe cases when the facial nerve is seriously deteriorating. These patients are at risk for permanent paralysis and have a poor prognosis without aggressive intervention. Research has shown that this procedure is effective in improving outcomes in a select group of patients. To be effective, the surgery must be performed within 2 weeks of the onset of symptoms.

Bell's Palsy, Surgery reprinted with permission from neurologychannel.com
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