The majority of facial paralysis cases in adults are caused by the inflammation of the facial nerve called Bell’s palsy. The disorder usually affects one side of the face causing a drooping of the mouth and impairing facial expression. The condition can also damage facial functionality causing drooling and lack of oral competence, drooping eyelids and excessive watering of the eye. Most patients with Bell’s palsy spontaneously get better, but if you have had a paralysis for more than a year or there is a different cause that is not reversible then surgery may help. Facial paralysis surgery aims to restore facial symmetry and allow coordinated facial movement, control of the mouth and eyelid closure.

What does the surgery involve?

The procedure for facial paralysis depends on the cause and the location of the damage. Sometimes surgery to relieve the pressure on the facial nerve (decompression) is carried out. Decompression is achieved by removing bone through an incision made behind the ear around the swollen nerve, such surgery is done usually by ENT surgeons (Ear, Nose and Throat specialists).

Other types of nerve damage, can be repaired with a facial nerve graft. This involves replacing parts of the damaged nerve with nerves from the neck. Following a facial nerve graft total paralysis occurs until the nerves grow. This process can take between 6 to 15 months.

Or facial re-animation procedures can be used to bring in new nerves or muscle transfers or muscle transplants to replace missing facial movements and restore form and function.  It is these reconstructive procedures that Mr Richard is able to do.

What to expect post surgery?

Specialist post op care:
> Patient should expect to stay in hospital for 1 to 4 days.
> TED stockings to be worn for 2 weeks.
> No restrictions but avoid strenuous activities for about the first 2 weeks.
> Moisturise all scars for at least 3 months.
> Avoid direct sunlight for the first 3 months.
Common side effects:
> Immediately following surgery there may be swelling in the ear causing temporary hearing impairment. Swelling usually subsides in 2 to 4 weeks and hearing is restored.
> Swelling in the inner ear commonly causes dizziness. This will subside a few days after surgery.
> Pain, swelling and bruising that can last up to a month.
> Scarring usually fades but won’t completely disappear behind the ear.

Uncommon but potential complications:
As with any operation problems may arise with an unexpected reaction to the anaesthetic, excessive bleeding, blood clots or infection. Complications can occur during or after the procedure.

Risks specifically related to facial paralysis surgery include:
> Some weakness in the face may remain permanently.
> Very rarely scar tissue forms in the ear causing permanent damage to hearing.

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