Particularly, facial nerve palsyis the most common neurological damage to the cranial nerve, which when it occurs, leads to weakness or paralysis of facial facial muscles.

In addition to the muscles, the personal nerve carries nerve fibers for the lacrimal and salivary glands, as well as nerve fibers for the transfer of the sense of taste from the tongue to the brain.

What are the symptoms of facial paralysis?

The symptoms displayed by the patient during facial paralysis are:

• Asymmetry in the face with a pull of the corner of the mouth towards the healthy side
• Disappearance of forehead wrinkles
• Disappearance of nasolabial fold
• Hare eye (Inability to tighten the eyelid)
• Ectropion (lower eyelid drooping)
• Inability to raise eyebrows
• Inability to show teeth
• Inability to whistle
• Inability to “puff” the mouth

What are the causes of facial paralysis?

“The most common form of facial paralysis is Bell’s palsy. In this case, usually the paralysis is temporary and in a large percentage the recovery is complete. However, there are some cases of paralysis associated with infections, mainly viral.

The most common is due to the virus VZV (herpes zoster) which causes a skin rash around the ear, severe pain and loss of taste, which if not treated within 72 hours, can become very serious and cut the chances of recovery in half of the cases”, emphasizes Mr. Andreas Gravvanis Director of Plastic Reconstructive Microsurgery and Aesthetic Surgery Unit in the Metropolitan Hospital and continues:

“At the same time, other cases are connected with volumeswith more frequent the acoustic neuroma, while less commonly, paralysis is due to tumors of the facial nerve, various tumors of the bridge-cerebellar angle, neurofibromatosis type II, and tumors of the parotid gland. Mastoiditis and otitis media and otitis externa can also affect the facial nerve.

Causes also include a hemangioma, carotid artery aneurysm, or arteriovenous malformation, which can cause displacement and pressure on the nerve in the case of paralysis. Other factors include head trauma with temporal bone fracture, sarcoidosis, Miller Fisher syndrome, Guillain-Barre syndrome and multiple sclerosis,” he adds.

How is facial paralysis diagnosed?

“In most cases, the clinical examination is enough to make the diagnosis. For example, facial paralysis on one side, without other neurological symptoms, suggests an idiopathic facial paralysis. However, when there are other neurological symptoms, such as vision problems, numbness or unsteadiness, then an MRI of the brain is necessary to identify the cause.

The same applies in the event that only a drop in the corner of the mouth is observed, to exclude the case of a stroke. If the examination shows redness and blisters at the entrance of the ear canal, accompanied by pain, then it is necessary to make an assessment by an ENT” he says.

What are the ways to deal with it?

“The goal of surgery is to achieve significant improving functionality and appearance, in order to ensure the social and professional reintegration of the patient. A central objective is the closing of the eyelid to protect the cornea of ​​the eye, as well as the restoration of the patient’s smile, which additionally has a positive effect on speech, food intake and saliva control. The surgical treatment of paralysis is distinguished in early (immediate) and late (distal) phase’ notes the expert.

Early paralysis

It is defined as the paralysis within the first 2 years of its onset, when it is considered that the muscles have not permanently atrophied.
“In cases of early paralysis from causes such as intracranial injury from accident or surgery, there is an indication for immediate renewal of the mimic muscles of the face. This is achieved through the connection of various combinations of nerve transfers, known as nerve transfers, i.e. the masseter nerve in combination with a branch of the contralateral healthy facial nerve (cross face nerve graft),” says Mr. Gravvanis.

Chronic paralysis

Distant or chronic is characterized when a period of two years has passed since the onset of the paralysis, resulting in the manifestation of paralysis of the neuromuscular synapse and therefore the definitive paralysis of the mimic muscle. In this case, improvement usually consists of transferring functional muscles to restore permanently paralyzed muscles, in two or more surgical stages. Initially, the contralateral healthy personal nerve is usually used to innervate the muscle, using a nerve graft, usually the gastrocnemius.

In the second stage, after 6 to 9 months, a period that allows nerve regeneration, the microsurgical transplantation of the muscle is carried out, which will have dynamic movement due to its connection with the regenerated nerve graft. This method allows achieving a relatively normal smile that is in sync with the healthy face.

However, as a procedure it also comes with disadvantages, such as two surgeries, additional scarring on the healthy face, and possible morbidity from receiving the nerve graft. In addition, considerable time is required for recovery, which is estimated at about a year and a half.

The one-step method

“In recent years, the one-stage strategy has prevailed worldwide. It is a restoration of facial paralysis through the microsurgical transplantation of the adductor muscle, whose reinnervation is achieved by directly connecting the nerve with the nerve of the masseter muscle.
This method offers advantages over the traditional two-stage procedure, as it provides a solution to the patient with a single surgery and results in approximately 3 to 4 months. In addition, the healthy side is not burdened with interventions and further scars are avoided, while a strong smile is ensured, which may, however, lack naturalness” concludes Mr. Gravvanis.

*Based on the modern need of the individual to improve his appearance and with the aim of ensuring the effective treatment of any visible imperfection, the Metropolitan Hospital has an innovative Plastic & Reconstructive Surgery Clinic, which collaborates with different departments of the Hospital, in order to provide comprehensive health services for all problems that require specialized treatment. The Clinic has fully qualified medical and nursing staff, as well as state-of-the-art equipment in order to stand worthy among European clinics, offering personalized solutions to each patient.