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We understand the challenges
At UW Health, we understand the challenges facial nerve paralysis brings. At our Facial Nerve Clinic, our extensive team of specialists is ready to help. We offer advanced surgical and nonsurgical treatments. We also offer emotional and psychological support.
Types of facial nerve paralysis
When you have facial nerve paralysis, one side of your face droops. On very rare occasions it can happen on both sides of your face. It may make it hard to smile or close your eyes and can change the way your body produces saliva and tears. It can also cause pain in your ear and make it more sensitive to sound. The paralysis can change your sense of taste on one side of your tongue and make it hard to speak as well.
Acoustic tumors (vestibular schwannoma) are slow growing noncancerous tumors that occur between the brain and inner ear. They can compress the facial nerve, leading to facial paralysis. Larger tumors can also affect eye movement, swallowing and speaking.
Bell’s palsy is the most common type of facial nerve paralysis, though it’s not clear what causes it. Experts think it may result from a viral infection that leaves your facial nerve inflamed. Facial muscles — usually on just one side of your face — become weak or unable to move.
With time, symptoms usually resolve, but they can be alarming, and should be evaluated quickly. Other more serious conditions can cause similar problems and must be ruled out. If you do have Bell’s palsy, early treatment can increase your chances of a full recovery.
Facial paralysis causes weakness to many muscles of the face. In flaccid paralysis (a chronic type of facial nerve paralysis), all muscle tone is lost and no movement exists, resulting in eyebrow and lower eyelid droop, inability to close eye, midface sagging, nasal twisting and obstruction, lower face droop with sagging at the corner of the mouth, difficulty eating and inability to smile.
Ramsay Hunt syndrome is caused by a shingles outbreak (the same virus as chickenpox). It occurs when the outbreak is close to one of your ears and affects your facial nerve. It can cause facial nerve paralysis and hearing loss.
Although many patients with facial paralysis will see improvement, sometimes the facial muscles can "over-correct" causing the face to become tight, stiff or "heavy." The eye may appear small. The crease between the side of the nose and corner of mouth (nasolabial fold) may seem deeper than the unaffected side. In some cases, the facial nerve can heal improperly causing muscles to contract out of sequence at the same time. For example, the eye may close during a smile or pucker, or the cheek may pull up when the eye closes. This improper movement, called synkinesis, can result in uncoordinated or distorted facial expression.
Retraining and reanimation
Doctors don’t always find a definite cause for a person’s facial drooping. Many times, symptoms will resolve on their own usually within three months. Whether your paralysis is new or long-term (chronic), the Facial Nerve Clinic can help you.
Treatment depends on your condition and when it developed.
Bell’s palsy treatments
Since most cases of Bell’s palsy have an excellent chance for recovery, specialists recommend that patients rest the affected area for at least three months after initial consultation. Usually no therapies should be considered aside from oral medication. Learn more
If paralysis has been present for more than three months, you should be seen for a comprehensive evaluation at the UW Health Facial Nerve Clinic. We may order imaging tests or perform electromyography testing (EMG) in cases where it is not clear if the facial muscles are recovering. The facial nerve team may recommend surgery or physical therapy that can help alleviate the residual effects of paralysis both functionally and cosmetically. Learn more
Reanimation surgery for chronic (long-term) facial paralysis
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:
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 training 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.
Tumor- and trauma-related surgery
Nerve paralysis can be a result of trauma to your facial nerve. Certain tumors can lead to facial nerve paralysis as well. We offer several treatments in these cases:
Reattaches the damaged nerve. It can take six months for the nerve to regenerate and improve muscle movement. Synkinesis (abnormal movement) might result, but facial retraining can help.
An option when we can’t reattach a severed nerve without causing too much tension on the nerve. The procedure involves taking a graft from a different nerve and placing it between the two segments of severed facial nerve. This can also take up to six months to work and may cause synkinesis.
A treatment for cancer patients who have large portions of facial tissue removed during surgery. It involves moving muscle and other tissue to the area in addition to fixing the damaged nerve. The surgery gives shape and volume to your face.
Condition: Facial paralysis after brain hemorrhage
Background: This patient had emergency surgery to repair a brain hemorrhage (bleed) in her brainstem that left her a quadriplegic and with right sided facial paralysis. After two years, she regained function of her limbs, but had only a return of tone to the face and some limited movement of the lips.
Treatment: Facial reanimation surgery was performed to “animate” the paralyzed right face. Surgery included a masseteric-to-facial nerve neurorrhaphy, also known as a “5-7 nerve transfer” to bring nerves from the right masseter (chewing) muscle to the muscles that move the right face. She is now able to smile by biting on the right side and has remarkable improvement in resting symmetry.
Condition: Synkinesis after resection of vestibular schwannoma (acoustic neuroma)
Background: This patient underwent surgery to remove a large tumor on her hearing & balance nerve called a vestibular schwannoma (acoustic neuroma) resulting in left sided facial paralysis. After 15 months of recovery, she came to the Facial Nerve Clinic with significant difficulty with smiling and eye closure. She was diagnosed with synkinesis of the left facial muscles and weakness of the forehead muscles.
Treatment: Specialized neuromuscular retraining therapy sessions for her synkinesis. Botox® injections were added to treat the platysma muscle of the neck and around the eye for the remaining tightness from her synkinesis.
Synkinesis after Bell’s palsy
Condition: Synkinesis after Bell’s palsy
Background: This patient arrived at the Facial Nerve Clinic with untreated left sided synkinesis because of Bell’s palsy 35 years prior. She could not raise the left side of her mouth to smile and had asymmetric drooping of her eyebrows causing vision impairment. She was diagnosed with synkinesis of the left facial muscles and obstruction of her vision due to her brow and eyelids.
Treatment: To treat her synkinesis, she had neuromuscular retraining therapy and Botox® injections. Surgery was also performed with endoscopic brow lift and bilateral upper eyelid blepharoplasty.
Transformative, life-changing stories of success
A more natural smile will mean the world to her.
Frequently asked questions
Answers to the most common questions
The following resources can help you better understand your condition and prepare you for your visit to the Facial Nerve Clinic.
Frequently asked questions
Meet our team
Our specialists can help
At UW Health, we have specialists in ear, nose and throat surgery, facial plastic surgery and head and neck surgery. They’re joined by neurosurgeons and oculofacial plastic surgeons who specialize in disorders of the eyelids, tear ducts and face. Our team also includes health psychologists and physical therapists who focus on facial nerve paralysis.
Evaluating facial paralysis and synkinesis
Our quick reference tools assist providers in evaluating facial paralysis and synkinesis in their patients and also include referral information to the Facial Nerve Clinic.
How to find us
If you have facial paralysis, schedule an appointment at our convenient location today.