Bell’s Palsy : We’re here to provide answers

Your doctor may prescribe an oral steroid to help reduce inflammation and irritation of the facial nerve. Studies have shown this can improve the chances for recovery when prescribed within 72 hours of symptom onset.

If you cannot be seen by your doctor for new facial weakness, you should go to the nearest emergency room so the emergency doctor can look for other serious causes and discuss medications with you.

Getting eye care as soon as you notice any facial drooping is extremely important. If you can’t close your eyes, they may become dry and scratched. Without proper care, the damage may be permanent. Your doctor can advise you on how to care for your eyes and may refer you to an eye specialist.

These home-care tips can help, with proper follow-up with an eye doctor:

• Use eye drops such as “artificial tears” frequently during the day.

• Use over-the-counter eye ointment at night. Within seven to 10 days of starting the ointment, be sure to see an eye doctor.

• Use a moisture chamber at night.

• Use an eye patch or eye taping when sleeping after discussing this with your eye doctor.

• Wear wraparound sunglasses when outside.

Facial nerve decompression relieves pressure on your facial nerve. Sometimes the nerve is so inflamed that it gets squeezed near your inner ear. Ask your primary care doctor about seeing a neurotologist (ear surgeon), because this surgery should take place less than two weeks after the paralysis starts. The surgeon will help you determine if this treatment is right for you.

Eyelid weight surgery may be possible for people who find it difficult to close their eyes completely. This surgery involves placing a small weight in your eyelid. We may recommend it if you’ve had facial paralysis for longer than a few months. If you recover, we can remove the weight.

We use nerve input from the working side of your face to animate the paralyzed side. This procedure involves taking a sensory nerve (the sural nerve) from your lower leg. We use that nerve to wire new connections between branches of the facial nerve on the working side of your face and nerve branches of facial muscles on your paralyzed side. Surgeons tunnel the nerve across your face under your nose. The cross-face nerve graft can be combined with a muscle transfer from the upper leg to achieve smile function.

We may use dynamic procedures when you’ve had paralysis for a long time. After one to two years, your facial muscles won’t be able to move on their own. These procedures involve moving muscles and nerves from other parts of your body (free tissue transfer) to reanimate your facial movements. The cross-face nerve graft can be combined with free tissue transfer. The primary muscle used in free tissue transfer facial reanimation is the gracilis muscle. This is a thin muscle on the inside of the upper leg that can be transferred to your face with no significant changes to leg function. We can also use the temporalis muscle (muscles on the sides of your head) to restore facial tone and a dynamic smile. This can be done in a few different ways and involves connecting the temporalis muscle, which is activated with biting, to the corner of the mouth. When the muscle contracts with biting down, the corner of the mouth will move in a smile direction.

We use part of the nerve that normally helps you move your tongue. We connect it to your facial nerve to stimulate facial nerve muscles. This procedure is particularly useful in restoring the muscle tone of the face so that at rest the face has a symmetric appearance. A portion of the hypoglossal nerve (40%) is divided and connected to the facial nerve and fortunately this division of the hypoglossal nerve rarely causes any changes in tongue function.

We connect your masseteric nerve to your paralyzed facial nerve to restore your smile. The procedure utilizes the nerve from one of the muscles involved in chewing (the masseter muscle on the side of the cheek). However, this doesn’t cause significant problems with eating or mouth opening. Over time and with the use of neuromuscular retraining physical therapy many patients can smile without having to bite down to activate the nerve.

Some people with facial drooping have a lot of trouble closing one eye. In certain cases, surgery to place a small upper eyelid weight can improve this function. This can be combined with tarsal strip tightening or lateral canthopexy to repair a loose or floppy lower eyelid.

If you’ve had facial paralysis for one to two years, your muscles begin to break down. Movement may not return on its own. Static procedures lift sagging or drooping parts of your face and restore a more natural appearance.

Static procedures include:

• Facelift

• Lower lip wedge resection/removal

• Nasal surgery to hold the nose in an open position

• Static sling to raise the corner of the mouth at rest

• Brow lift to raise drooping eyelids

Facial retraining uses specific techniques to improve the way you control your facial muscles. The goal is to retrain your brain and nerves. A specially trained physical therapist guides you through the program.

Botox relaxes the muscles that have become too dominant in synkinesis. This creates a better, more balanced appearance. Your insurance may require an alternative to Botox that works equally well.