Facial Nerve Surgery
The most effective way to return motor function to the face is the microsurgical repair of the facial nerve, also known as the seventh cranial nerve. This treatment may be needed following:
- Inadvertent surgical division during another surgery
- Removal during tumor extirpation
Who should undergo a facial nerve surgery?
The most important consideration for the facial nerve surgery procedure is minimizing the time between the nerve damage and its reconstruction. The sooner the surgery can be completed, the greater the chances of a successful and quick recovery. Patients who seek to repair damage that has long been healed will have the previous scar tissue and neuromas removed to create raw surfaces for nerve reconstruction, though this procedure may not achieve similar results. Another consideration for this procedure is that there must be vital muscle still present in the paralyzed face that may be rescued.
What happens during surgery?
Facial nerve reconstruction occurs using 2 distinct methods, both of which are performed under general anesthetic due to the sensitive nature of nerve repair. The first method is direct repair and entails the surgical attachment of the 2 severed ends of a nerve. This is only possible when the severed nerve section has not sustained a loss of neural tissue. For this procedure, a tiny incision may be made near the damage site, or possibly in the upper neck behind the ear. The 2 ends of the nerve are connected using microsurgery, and the incision closed, allowing the nerve cells to regenerate and become functional once more.
In situations that have led to a loss of neural tissue or other complications that prevent direct repair, a surgical neural graft is used from nerves elsewhere in the body, including those in the earlobe or the outer edge of the foot. This graft is placed over the remaining nerve ends to bridge the gap between them. While this grafted nerve does function as a new nerve, it provides the overall framework for the nerve to repair itself over time. The grafted nerve is attached to both nerve ends with microsurgery and the incision is closed.
What should I expect after surgery?
A dressing may be applied to the area following the procedure and a drain used if necessary to remove excess fluid buildup. Some swelling may occur in the first few days, and should diminish in a few weeks. Bruising is also possible, and should diminish in 5-10 days. The procedure may be done on at outpatient basis, but may sometimes require hospitalizations of 1-3 days. Prescription or over-the-counter pain medication may be used as needed to manage any pain or discomfort.
Nerve regeneration is a slow process and may progress at a rate of about 1 millimeter a day, meaning that total recovery can take many months depending on the injury. Function of the facial muscles may continue to improve for up to 2 years. Each recovery process is different, and more specific recovery instructions, expectations and a timeline will be given to you following your surgery.
Very unlikely complications following this procedure include infection, asymmetric healing, bleeding and changes in sensitivity. Nerve grafts from other areas of the body may result in sensitivity changes at the donor site.
If you have experienced facial nerve damage recently or in the past and would like to discuss your options, please feel free to contact us for a consultation.