Facial Nerve Grafting

Unilateral Facial Nerve Paralysis is seen in practise usually due to newborn babies' birth trauma, tumour removal either inside the skull (acoustic neuroma or cerebral tumour) or outside (parotid tumour), or due to severe damage to the facial nerve by trauma or infection (Bell's Palsy).

The microsurgery Cross Facial Nerve Graft, first performed successfully in Australia in 1974 by Professor Owen, remains perhaps the best way of achieving a natural facial symmetry and smile.

In this 2-hour operation, surgical trauma to the patient is minimal. The 1 cm facial incisions are hidden in smile lines on either cheek and patients wake up facially pain-free and with only bandaids on their cheeks. The 16 cm nerve graft from the sural nerve in one leg is carefully dissected out and causes little discomfort post operatively and the little steps scars in the leg are minimal.

How Can Facial Muscles Work After So Many Years of Paralysis?

We have biopsied where facial muscles should be years after facial nerve paralysis and have not found much to promote hope, however, successful surgery in patients born with complete one-sided paralysis and operated upon up to 20 years later can produce almost normal smile muscle activity and tone to confer symmetry at rest.

One explanation could be the privileged site of the facial muscles and facial nerves, preserved in the thin very vascular tissue between facial skin and mouth mucosa. This provides a very warm active environment indeed for the facial (7th cranial peripheral) nerve and its totally motor fibres supplying only the extremely thin 'short-span' special muscles of expression, which can regenerate.

What are the Results of Facial Grafts?

The best results occur with grafts for recent damage to the intra-cranial course of the facial nerve. Similar results occur from repairing congenital (seen at birth) paralysis. Less consistent results occur when doing this procedure for Bell's Palsies, where the viral damage may not only be to the facial nerve before it emerges from the bony canal. The disease may have affected the lower facial components of the nerve and it may not recover very much activity when joined to the graft. In all cases the results are seventy percent satisfactory to the patient as far as restoring some or most of the symmetry and smile. In only a few cases however, does movement return to the upper eyelid but a simple gold weight or spring implant helps here. Regeneration of nerve takes a fortnight per cm so expect at least nine months delay to reach and begin to activate a facial muscle. Improvement occurs steadily for the next five years.

Professor Owen's surgical team, now operating at the Castlecrag Private Hospital for over 10 years, has been together for 19 years. The hospital's services, food and care delight the patients who come from all over Australia and all parts of the World to be cared for by this highly acclaimed microsurgery team.