Many factors go into determining the most appropriate intervention for facial nerve paralysis, especially when facial reanimation procedures may be indicated. The cause and duration of your condition will help guide treatment options as will evaluation of your overall health. Below are listed some basic categories of reanimation procedures.
Primary anastamosis — When paralysis is secondary to discontinuity of the facial nerve and there is not significant nerve tissue missing (less than 15 mm), the cut ends may be able to be reapproximated with eventual return of some function.
Interposition grafts — When paralysis is secondary to discontinuity of the facial nerve and there is more extensive nerve tissue missing (greater than 15 mm), the cut ends may be able to be bridged with an interposition graft to provide a conduit for regenerating nerve fibers to allow eventual return of some function. Acquiring the graft may require an additional incision and lead to loss of sensation or function from the donor site.
Cross facial nerve grafts — If the proximal nerve end is absent but the distal branches are intact, cross facial nerve grafting may allow grafting from the facial nerve on the opposite side of the face to provide input to the facial nerve branches on the side with the deficit. Again, acquiring the graft may require an additional incision and lead to loss of sensation or function from the donor site.
Nerve transposition — Another motor neuron in the same region may be used provide input to the injured facial nerve. This may be an additional option to provide dynamic function to facial muscles and may be used alone or in combination with cross facial nerve grafting.
Regional muscle transfer — This may be an option to restore some facial movement in the setting of long-term, irreversible facial paralysis. A nearby muscle may be reoriented and attached to the drooping corner of the mouth to restore some degree of function.
Static procedures — Several static procedures may be used alone or in conjunction with other procedure to restore a more natural resting appearance to the face and protect the eye when incomplete eye closure is present. These can include browlift, tightening the eyelid, lifting the corner of the mouth and/or nose, and placement of a weight in the eyelid to assist in closure.