***This page is under review***
Patients may have facial deformity for a variety of reasons including hemi facial microsomia, Parry-Romberg syndrome or following facial trauma or ablative surgery.
Unilateral facial paralysis may result from skull base or facial trauma, Bell’s palsy or following excision of an acoustic neuroma or other neurosurgical procedures. Many other rare aetio logies exist. Bilateral facial paralysis is less common but may occur in association with congenital Moebius syndrome.
The majority of Bell’s palsy patients will recover spontaneously, especially when treatment with steroids and antivirals is instituted promptly. Some cases however do not recover fully or at all and surgical intervention may be required to improve facial symmetry and function, so called Smile surgery.
Please ensure that an ENT assessment has been undertaken for patients with Bell’s Palsy before a plastics referral is made.
After more than 12 to 18 months following the onset of paralysis, the motor endplates to the facial muscles degenerate to the extent that these muscles cannot be re-innervated and the only dynamic reconstructive options involve temporalis muscle transposition or the transplantation of muscle from elsewhere in the body into the face and its connection to a blood supply and donor nerve. For this reason it is important that patients with facial paralysis are seen as early as possible if it is known that there is likely to be little or no prospect of recovery. If treatment is performed before 12 months it may be possible to re-innervate the innate facial musculature using cross facial nerve grafts or alternative donor nerves.
A number of other surgical techniques are commonly used for the treatment of patients with facial paralysis, including the placement of gold weights into the upper eyelid to assist with eyelid closure. Static tendon slings and facelift techniques can be employed to elevate the lower eyelid and cheek into more functional and aesthetic positions. Botulinum toxin may be used to paralyse muscles on the contralateral lower lip and brow to improve symmetry.
Who to refer:
- Patients with a persistent facial paralysis following appropriate investigation and exclusion of malignant aetiologies.
- Any patient with stable facial deformity after appropriate investigation of the aetiology.
Who not to refer:
- Patients with an acute onset of facial paralysis of unknown cause should be first be referred to neurology, neurosurgery or ENT for investigation, especially in the presence of suspected intracranial pathology or parotid malignancy.
- Bell’s Palsy patients should be assessed by an ENT Clinician before a referral for cosmetic surgery.
How to refer:
Via SCI gateway to the Facial Reanimation clinic of the Plastic surgery service at St John’s hospital with appropriate details and background information.
