Was it a stroke? Was it an accident? Was it a tumor?
Most patients remember the day it happened. Afterwards, nothing is the same. Facial paralysis is like having your house burn down. Your family may be fine, but your house is still gone.
It’s not possible to rebuild a house exactly like it was before. Our goal with facial paralysis is restore facial function, symmetry, and movement as best possible. The ultimate goal is to allow patients to move on beyond the injury.
Facial nerve paralysis has many forms and many treatment options. To help us focus your visit, please ask yourself, “What is the one most important thing for me to address?”
Surgical options
While these topics will be discussed in greater detail during your consultation, we find it helpful when patients have a background in treatment solutions.
SMILE SYMMETRY
Nerve Graft
If the cause of facial paralysis is recent, it may be possible to repair the nerve directly.
If the facial nerve on the paralyzed side is no longer available, a nerve is borrowed from either the other side of the face or from one of the muscles for chewing. Borrowing a nerve from elsewhere can produce movement on the paralyzed side. Nerve surgery is a developing field so results can be excellent, but can also vary from patient to patient.
Temporalis Muscle Transfer
Temporalis muscle transfer is an excellent option for patients who want a predictable result with shorter operative time and possibly only one surgery. A muscle that helps with chewing is borrowed to help raise and move the lip. After surgery, the patient will have to train himself or herself to use this muscle in a new way to smile spontaneously.
Gracillis Free Tissue Transfer
This option is appropriate for younger, healthy patients, who are willing to undergo multiple surgeries. While the result may be better than temporalis muscle transfer, it does involve longer operative times. Because gracillis free tissue transfer involves more steps, the results are more variable.
If the contralateral side of the face is chosen as a donor nerve, a nerve graft placed to allow this nerve to grow to the paralyzed side. The growth of the nerve graft can take many months. Afterwards, the gracilis free tissue transfer surgery is performed. The gracilis free tissue transfer surgery can be performed without this first step if a nerve from the paralyzed side of the face is selected.
The gracilis free tissue transfer surgery involves transplanting a minor muscle in the medial leg into the paralyzed side of the face. A nerve is then attached to “power” the muscle. Afterwards nerve growth into the muscle to allow movement will take several months. However, for a young and motivated patient, the gracilis free tissue transfer can be an excellent option.
EYE DRYNESS OR ASYMMETRY
The facial nerve inervates the orbicularis oculi muscle to close the eye. The ocular motor nerve innervates the levator palpebrae superioris muscle to open the eye. That is why patients with facial paralysis will usually be able to open their eye even if they cannot completely close it.
The ability to close the eye is critical to protecting and lubricating it. Patients who are unable to close the eye spontaneous may feel as if they constantly have sand in their eyes.
A gold weight procedure is used to help with eye closure. With the patient’s input, we select a gold weight that closes the eye but does not feel too heavy. The procedure is done using an upper eyelid cosmetic surgery incision. Patients go home the same day of surgery.
The lower eyelid on the paralyzed side may appear asymmetric to the contralateral side. This can be from laxity of the orbicularis oculi muscle. This may contribute to dryness. A canthoplasty is a procedure that addresses these issues. A small access point is made in the crows feel of the eyelid skin just like many lower eyelid cosmetic surgeries. The eyelid is tightened and adjusted to the individual patient’s needs. Patients go home the same day of surgery.
FOREHEAD ASYMMETRY
Patients with facial paralysis loose movement and tone to the forehead muscle called the frontalis. This can result in the eyebrow on the affected side to droop with gravity. A tired or unhappy look can result. By lifting the forehead, much like a cosmetic browlift, the eyebrow dropping can be addressed. This procedure may also help vision if the eyebrow hands so low as to obstruct upward gaze. Patients go home the same day of surgery.
MUSCLE SPASMS
– Injectable wrinkle relaxer for lines
Patients with facial paralysis may have muscles spasms or irregular lines. A common solution is to use FDA approved wrinkle relaxer to soften muscles that spasm. Areas of deeper wrinkles can be smoothed for greater facial symmetry.
What to bring for initial consultation?
Your time is valuable, so we want to help you get the most of your consultation. Please bring the following if it applies to your appointment:
– Operative Records
– Pictures
– EMGs and neurological test results
– CT scan and MRI reports and CDs, if available
Why us?
There are two things that make us truly different–honestly, and expertise.
There are many types of plastic surgeons. Mark Domanski would like to be known as “an ordinary guy, in the best sense of the word.” Some surgeons have instruments named after them. There are Dr. “Metzenbaum” scissors. Some surgeons have a technique named after them. There is the Dr. “Gillies incision.” Dr. Domanski however is most proud of the difference he can make in patient’s lives.
Among plastic surgeons, there are some that specialize in aesthetics, and others in reconstruction. There are a few surgeons that are able to do both. Dr. Domanski’s is board certified in otolaryngology and plastic surgery. The American Board of Medical Specialties recognizes both of Dr. Domanski’s board certifications as independent boards. Consumers beware: there are many “board certifications” that do not meet this criterion.
Both otolaryngologists and plastic surgeons operate on the face. By combining these two fields, Dr. Domanski is able to offer an in-dept perspective on facial paralysis reconstruction. There are only a handful of surgeons in the United States with this educational background. There are a few that can offer this in a discrete setting of a private practice.
