Facial Nerve Paralysis

What is it?

It is a common problem that involves the paralysis of any structures innervated by the facial nerve. Its pathway is long, so there are many causes that may result in facial paralysis. It is characterized by facial weakness, with other symptoms including loss of taste, hyperacusis and decreased salivation.

The most common causes are:

  • Bell’s palsy. It is a sudden disease of unknown cause, that commonly resides on its own.
  • Tumors that compress the nerve, especially neoplasms of the parotid gland and acoustic neuromas in the inner ear. In that case, paralysis is slowly progressive.
  • Temporal fractures or skin injuries along the nerve route.

The procedure

We choose the ideal reconstructive option depending on the individualized problem. In cases of lagophthalmos (difficulty in closing the eyelids completely) I place gold plate in the upper eyelid. Regarding smile reconstruction we choose between static methods with fascial grafts and dynamic ones using free functional muscle flaps from the lower extremity (gracilis flap). The latter technique is preferable in young patients. When facial asymmetry is subtle, we can use botox injections to eliminate the differences between the 2 sides.


Local anesthesia for gold plates insertion. General anesthesia for more complex reconstruction.


Static methods and lagophthalmos correction have immediate results, while free flap reconstruction may require 6 months until facial movement can be observed.

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