Dr. Maas discusses the facial nerve as it relates to facial plastic surgery, and facial nerve paralysis. Learn more about facial paralysis or ask San Francisco Facial Plastic Surgeon Corey Maas your plastic surgery question.

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We’re going to take a few minutes today to talk about facial nerve paralysis. It’s very important consideration in facial plastic surgery in general because we work in and around the facial nerve with virtually every procedure we do.

The facial nerve is important because it’s a motor nerve or a movement nerve that starts from the bottom of the ear here in a small canal where it comes through the bone and spreads out almost like the fingers of your hand to supply the different muscles of the face. These nerve endings become superficial and are just under the muscle as they get very close to the corner of the eye and align that goes straight down from that medially toward the nose and it’s really a very important nerve because all of our facial expression derives from that nerve, it’s obviously two sided, there’s one on each side so you can have a facial nerve weakness or injury on one side and not the other or complete paralysis and I wanted to talk a little bit about the causes of facial nerve paralysis once that we see to some frequency and then others that are quite rare.

The most commonly known cause or really its unknown cause of facial paralysis as referred to as Bell’s palsy which was describe many years ago and really still to a large extent is considered idiopathic meaning we don’t really know what the cause of it is but I think most researchers, scientist and physicians like myself that work with it we believe that because the facial nerve travels a long distance from the brain stem through a very narrow boney canal all the way out to the face that the canal itself which is very thin and narrow as I said in cases in which the nerve might become slightly swollen or irritated or inflamed as in a viral type of infection can cause that nerve to shut down and weaken and you can have a small viral illness that causes Bell’s palsy. Most of us now if we see acute sadden onset of Bell’s palsy without other causes or nerve injury, on nerve weakness on one side or the other, we’ll treat that with a type of anti-viral agent acyclovir and also hydro steroids to reduce the swelling and in fact the outcomes now are improving in terms of long term.

Most of the time in the old days Bell’s palsy, the patient was sent home and told it will get better overtime and in fact in many cases it didn’t completely get better.

So Bell’s palsy is probably a viral origin it’s treatable in the acute stages and certainly if you have residua some weakness or irregularities or the facial nerve due to Bell’s palsy there are a lot of things we can do for that including using Botox and other products to balance the facial features.

The other more common type working in an academic center like I do are types of treatments that including brain tumors or skull-based tumors in which the facial nerve is either inadvertently injured or affected by the tumor these are often schwannomas or acoustic neuromas and in many cases that schwannoma will push on the facial nerve and cause weakness sometimes that’s the very first sign of the tumor so it helps the diagnosis to be made earlier.

Obviously trauma is one that people can’t control, facial nerve injury can happen from deep lacerations to the face. They can also occur in head injuries particularly in motor vehicle accident as where we see them most commonly.

The good news about trauma especially blood trauma is it in most cases the facial nerve will recover with proper treatment in time and we always encourage people we’ve had facial nerve injury is that we’re not cut now with this as blood traumas to give it time and there are certain therapies we can do to accelerate the recovery of the nerve.

With facial nerve recovery there are three or four major types of conditions that are treatable, things that we can improve. One of them is facial nerve weakness and usually again, that gets better with time. Another is a condition called synkinesis where you smile and the eye closes involuntarily or opposite to your smile when the eye closes things like that, this is a condition called synkinesis where the nerve action is not properly distributed through the face. Hyperkynesis where it’s constantly under too much tone, the brow maybe raised too high one side of the smile maybe pulling too hard. Those are things again that are treatable particularly with the Botulinum toxins, Botox, Dysport, Xeomin these types of products.

And finally, really there’s this condition where the facial nerve is not recovering very much at all and there’s incomplete closure of the eye. In those cases, we’ll use certain treatments and particularly surgical treatments like the placement of a gold weight or tightening of the lower eyelid to make sure that the eye closure is complete and that’s a really important milestone step in the treatment of facial browses even if we think it’s not going to be permanent.

We’ll get into facial nerve paralysis and some of the discussions for options for treatment and some more detail but I wanted to give an introductions and an overview in just really say that people that have facial paralysis or paresis weakness most often will get better and there are number of treatment options available to all of those patients.

If you have any questions about facial nerve paralysis who weakness and then would like to find out more information please don’t hesitate to call or write @DrMass.com, you can send photographs or even videos of yourself and I’m happy to answer you even privately or publicly if you’d like to share information with others that might have the same condition. This is Dr. Corey Mass on looking your best.