Facial nerve paralysis is a condition in which the nerve that moves the muscles of facial expression no longer works properly. The specialists of the University of Michigan’s Department of Otolaryngology-Head and Neck Surgery are experts in diagnosing and treating conditions that affect the facial nerve. Our Multidisciplinary Facial Nerve Clinic includes members from Facial Plastic Surgery, Neurotology, Audiology, Occupational Therapy, and Oculoplastic Surgery to ensure we’re treating all aspects of facial paralysis.
Problems Caused by Facial Paralysis
Facial paralysis can cause a number of problems, including:
- Difficulty closing the eye with drying and possible vision loss
- Nasal blockage
- Difficulty keeping liquids in the mouth
- A change in physical appearance
- A change in the ability to express emotion
Conditions Causing Facial Paralysis
There are many possible causes for facial paralysis, but some of the more common ones are:
- Bell’s Palsy – a nerve disorder that causes (usually) temporary paralysis
- Tumor or cancer requiring surgical removal of a piece of the facial nerve
- An error in fetal development or trauma during birth
- Accidental trauma to the nerve during a car accident or fall
- Autoimmune diseases, such as Wegener's disease
- Neurologic diseases, including multiple sclerosis
- Other infections, including Lyme disease or shingles of the face
- Chronic ear problems, such as cholesteatoma
Bell's Palsy and Facial Paralysis
The most common cause of facial paralysis is Bell's Palsy, which is thought to represent a viral infection of the facial nerve. Most patients with Bell's Palsy make a full recovery, but in rare cases, the nerve can be permanently injured. Also, the nerve may recover imperfectly, resulting in a condition called synkinesis, where facial muscles move unintentionally. Synkinesis can cause facial discomfort and is often distressing to patients, because their faces are no longer symmetric when they make certain facial expressions.
Treating Facial Paralysis
During your initial visit, we will collect a thorough history to ensure we understand the cause of your facial paralysis. If this is unclear, imaging studies, such as a CT scan or MRI may be necessary. In some cases where it is unknown if the facial nerve function will return, we ask our colleagues in Audiology and Electrophysiology to perform a study called an electromyogram (EMG), which measures the electrical activity of muscles. Once all tests have been performed and interpreted, our team will create a treatment plan based on the patient’s individual needs.
For patients with synkinesis (uncoordinated or unintentional facial movement) after a facial nerve injury, we can often significantly reduce facial discomfort and improve facial symmetry by injecting Botox. If the nerve was injured during trauma, we can often perform surgery to find the cut ends of the nerve and sew it back together.
For those who have a complete facial paralysis that is unlikely to recover, we offer a full range of surgical treatments to improve facial symmetry and function. These procedures include:
- Platinum weight placement in the upper eyelid to help the eye close more fully
- Lower eyelid tightening procedures to reduce tearing and improve the symmetry of the eyes
- No-scar mid-face lifts to reduce nasal blockage and bring the apple of the cheek back into its proper location
- A variety of procedures to improve the symmetry of the face and lips, including surgical and non-surgical options
We also perform procedures to help give patients back the ability to smile, which is so important in daily social interaction.