Facial Paralysis - Potential for Recovery? (photo)

There is a good chance function will continue to return to your face even after 18 months.  This can be monitored with various tests.  There may be a role using electrical stimulation of muscles.  If this falls short, there are operations to assist the weak areas of the face.

   At 12 months following an injury of this nature, you shold probably seek out a specialized facial nerve center comfortable with static slings, dynamic slings, nerve grafts including cross facial nerve grafts, and free innervated muscle grafts.  Waiting may be appropriate for a few more months, but you need specialists to guide you for the best recovery possible.  UCLA is a good place to start.

Dear Maya,


Starting with some nerve studies (EMG and ENoG) will give prognostic information (how likely the nerve will recover on its own)

Based on the results of these studies you can see if you would be a candidate for nerve surgery to fix it, or whether you should wait a little longer


Best regards,

Nima Shemirani

Sorry to hear about your problem.  Fist, you should be aware that there are an entirely different group,of nerves that supple sensation from those which provide movement.  So the fact that sensation returned without motor function makes sense and is not an indication that motor function will return.  Re-animation of the paralyzed face is a narrow sub-specialty within plastic surgery.  there are many things that can be done from the simple to the complex.Dryness of the eye can be treated temporarily with eye drops and nighttime ointment.  A simple surgical approach is to use a small gold weight I the eye specifically made for this situation.   Re-animation of the lower face is more complicated sometimes requiring  surgical procedures like nerve grafts or muscle slings, and likely will require multiple procedures.  Since you live in LA,  I would suggest calling the plastic surgery department at UCLA for starters.  Good luck!

The typical recovery happens in the first year, although it is possible for some recovery to occur after that.  It would a good idea for you to see a facial plastic and an oculoplastic surgeon, with facial/eyelid paralysis expertise, for possible dynamic and static surgical options in the meantime, besides keeping your eyes lubricated.  Dr. Azzizadeh and Dr. Nabili are expert facial plastic surgeons with this expertise in Los Angeles, who will work with an oculoplastic surgeon (such as myself) for best facial/eyelid result.

Sorry to hear about your acoustic neuroma surgery.  While recovery of facial nerve function is always possible, predicting the future is hard.  An EMG from a neurologist may provide some insight.  Depending on the likelihood of the nerve to regenerate, it might be worth considering nerve grafting or other procedures.  The challenge is that muscles undergo degeneration if they don't have a nerve stimulating them - so timing is important.  If one waits too long, nerve grafting is no longer an option, but other procedures to restore smile and symmetry remain.  Obviously, I would need to evaluate a patient in person to provide a specific recommendations rather than general thoughts.  Best of luck and I would be curious to see how your treatment goes!

I have taken care of many patients when I was in residency and performed many static and dynamic slings for this problem. The nerve can take at least 12-18 months to return so it would be very important to know if there has been any return of function over the past year. There are so many complex issues that are involved with facial nerve paralysis including dry eyes, drooping of the mouth leading to oral incompetence and many other issues I am sure you are well aware of. It is so important that you seek out experts in this field. You will need testing and a long conversation about the possibilities. It is not likely that much native function will return, however the sooner you see someone who can help you the better chance you will have for a procedure such as a cross facial nerve graft. These operations take several stages and the final result takes time. I applaud you for putting yourself out here on the internet. There is hope but you need to fall into the right hands. I would definitely start with a major academic institution like UCLA, however it seems from other posts there are some surgeons in the area that do this kind of reconstruction. Best of luck!!!
 

Maya, there is always a chance that the facial weakness will recover but the longer it takes, the less likely it will fully recover.  It can take up to 12-18months to regain function.  Has there been any improvement during the year?  There are a couple of ways facial weakness is addressed including surgical and non-surgical options.  The eye dryness should be addressed sooner than later with a gold or platinum weight that can be removed at a later time if/when the function recovers.

It can take upto 18 months sometimes for nerve function to recover.

You should be seeing a center or a surgeon who deals with this regularly.  I recommend that you discuss this with your otologic surgeon.

If the nerve function does not return, there are surgical interventions that can be performed that will improve the situation. There are diagnostic tests that can also be done to test nerve function. 

The best advice I can give you is to be enrolled in a center or with a surgeon who can follow and monitor your progress and be able to recommend and perform surgical interventions to improve the situation if your function does not fully return.

 

good luck.