Facial plastic surgeons at Penn Medicine are performing reanimation surgeries for patients with facial nerve dysfunction and paralysis resulting from trauma, disease or prior surgery.

Patients with facial paralysis endure the profound social stigma and isolation associated with disfigurement. In the absence of functional nerves that animate the face, normal facial responses to social stimuli and emotion disappear. The inability to contract the orbicularis oris compromises the normal labial seal, resulting in oral incompetence and articulation difficulties. The dilator nasal passages are often affected, leading to functional nasal obstruction, sleep disordered breathing and diminished sense of smell. When the orbicularis oculi are affected, dramatic cosmetic asymmetry occurs secondary to brow ptosis, lagophthalmos and lower eyelid laxity. The risks of corneal exposure in this setting may result in dryness, infection, corneal abrasions and/or ulcerations, and even blindness.

At Penn Medicine, the treatment goal for patients with facial paralysis is to restore them to an optimal quality of life, a renewed sense of confidence and a return to premorbid social activities and the workplace. Often, reanimation surgery is the best way to achieve these goals. Facial reanimation interventions have the potential to restore facial symmetry, oral competence, eyelid closure and, in some cases, voluntary animation of the facial muscles. Penn facial plastic surgeons offer a variety of reanimation interventions, typically as a series beginning with periorbital surgery to protect the eye and restore symmetry to the upper face.

These procedures might include brow lift surgery and ectropion repair accompanied by neuromodulator injections and other adjunct therapies. In time, with progressive dysfunction and asymmetry of the lower third of the face, hypoglossal facial anastomosis (facial nerve interpositional jump graft surgery), temporalis muscle transposition, gracilis free tissue transfer and other facial reanimation procedures may be performed.

Case Study

Pre-surgical photo of man with right-sided facial paralysis
Figure 1: Profound right-sided paralysis in a 73-year-old man following unintended transection of the facial nerve during surgery at the patient's community hospital.

Mr. M, a 73-year-old man, was referred to the Division of Plastic Surgery of the Department of Otorhinolaryngology-Head and Neck Surgery at Penn following surgery at another institution for a benign parotid tumor during which the facial nerve was inadvertently transected. This left him with partial right-sided facial paralysis (Figure 1), resulting in frequent tearing from the right eye, drooling from the corner of his mouth and profound social inhibition.

After a thorough consultation at Penn, Mr. M agreed to have facial reanimation surgery to address these concerns. During his surgery, the temporalis muscle was transferred to his mouth, providing motion and the ability to smile. His lower eyelid was tightened to reduce the tearing that was associated with lost tone of the eyelid’s orbicularis oculi muscle, and a weight was added to the upper eyelid to allow Mr. M to close (and thereby protect) his eye and vision from long-term drying and potential ulceration of the cornea.

Photo of man following surgery to correct right-side facial paralysis
Figure 2: The same patient following facial reanimation surgery involving temporalis muscle transfer from the scalp to the corner of the mouth, and procedures to correct lost eyelid tone and function.
Images: Penn Division of Plastic Surgery, Department of Otorhinolaryngology-Head and Neck Surgery

Following his surgery, Mr. M remained in the hospital for two days, then went home to recuperate. At a follow-up visit a year later, he was able to demonstrate oral competence and regained facial expression on his right side (Figure 2) and reported a higher quality of life and an ability to re-engage in family life and interactions with the outside world.

Access

Otorhinolaryngology-Head and Neck Surgery

Division of Facial Plastic and Reconstructive Surgery
Hospital of the University of Pennsylvania
3400 Spruce Street
5 Silverstein
Philadelphia, PA 19104

Penn Medicine Radnor
250 King of Prussia Road
Radnor, PA 19087

Pennsylvania Hospital
811 Spruce Street
Philadelphia, PA 19107

Division of Plastic Surgery

Center for Human Appearance
Perelman Center for Advanced Medicine
3400 Civic Center Boulevard
East Pavilion, 1st Floor
Philadelphia, PA 19104

Published on: June 23, 2017

References

About the Penn Department of Otorhinolaryngology-Head and Neck Surgery

The Department of Otorhinolaryngology-Head and Neck Surgery at Penn Medicine provides expert diagnosis and treatment of disorders in the ear, nose and throat as well as those in the head and neck area. The Department logs over 86,000 patient visits each year, the highest volume in the nation of any center or program performing otorhinolaryngology - head and neck surgery. The Department is actively involved in research, including investigations of the efficacy and safety of TransOral Robotic Surgery (TORS) in a variety of indications.

Penn Faculty Team

Bert W. O'Malley, Jr., MD

Associate Vice President, Physician Network Development

Chair, Department of Otorhinolaryngology - Head and Neck Surgery

Co-Director, Head and Neck Cancer Center

Gabriel Tucker Professor of Otorhinolaryngology: Head and Neck Surgery

Professor of Otorhinolaryngology in Neurosurgery

Professor of Radiation Oncology

Steven B. Cannady, MD

Director, Microvascular Surgery and Education

Assistant Professor of Clinical Otorhinolaryngology: Head and Neck Surgery

Ara A. Chalian, MD

Director, Facial Plastic Reconstruction

Director, Microvascular Lab

Patient Safety Officer

Professor of Otorhinolaryngology: Head and Neck Surgery at the Hospital of the University of Pennsylvania

Oren Friedman, MD

Director, Facial Plastic Surgery

Associate Professor of Clinical Otorhinolaryngology: Head and Neck Surgery

Jesse A. Taylor, MD

Associate Professor of Surgery at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia

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