Restoring facial harmony after facial palsy
Introduction to surgery for facial tightness (synkinesis):
Facial synkinesis (facial tightness) is a condition characterised by the unwanted movement or contraction of certain facial muscles that occurs with the intentional movement of other facial muscles. It often develops as a result of nerve damage or injury, particularly to the facial nerve, which controls the muscles responsible for facial expressions.
When the facial nerve is injured, such as in cases of facial paralysis or Bell's palsy, the nerve fibers may regenerate abnormally and connect to the wrong muscles or to muscles that were not previously connected. This abnormal nerve re-wiring leads to the phenomenon of synkinesis, where unintended muscle movements occur during voluntary facial movements.
Patients can experience significant discomfort with these unwanted movements. Furthermore, the unwanted movements act to restrict the amount of desired movement in certain areas (such as smiling), or cause excessive movement in other areas (such as eye closure).
A number of surgical options exist for treating facial tightness after facial palsy:
- Selective Neurectomy: This procedure involves surgically removing or selectively cutting the very end branches of the facial nerve that are causing abnormal facial movements. By disconnecting the overactive nerve fibres, the unintended muscle contractions can be reduced or eliminated.
- Muscle Resection: In certain situations, muscle resection may be performed to address synkinesis. During this procedure, a portion of the overactive muscle is surgically removed to reduce its bulk and improve muscle balance. This can help alleviate abnormal movements and improve facial symmetry
- Nerve Transfer: In cases where parts of the facial nerve have been permanently damaged or do not regenerate properly, a nerve transfer procedure may be considered. This involves taking a healthy nerve from another part of the body, such as the the chewing muscle, or from the healthy side of the face, and connecting it to the facial muscles. This allows for more activity in the desired area to help overcome the abnormal movements in other areas.
- Botulinum Toxin Injections (Adjunctive to Surgery): Botox® injections can be used in conjunction with surgical procedures to further optimise outcomes. Injecting Botox® into specific muscles can help fine-tune the results by providing temporary muscle relaxation and reducing residual unwanted movements.
It's important to note that the selection of the appropriate surgical procedure will depend on the individual's specific condition, the extent and location of facial tightness, and the underlying cause. Mr Butler will do a thorough assessment to help determine the most suitable surgical approach.
Key details of the procedure:
- Duration: 3 hours
- Cost: $25000 to $30000
- Anaesthetic: General anaesthetic
- Length of stay: 1 night in hospital