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Bell’s Palsy

Facial nerve paralysis is a dysfunction of cranial nerve VII (the facial nerve) that results in an inability to control the facial muscles on the affected side. Several conditions can cause a facial paralysis (e.g., brain tumor, stroke, and Lyme disease). However, if no specific cause can be identified, the condition is known as Bell’s palsy. Patients will have some weakness to one side of the face, and depending on the severity, the eyelid can be affected. They can have variable weakness in blinking and shutting their eyelids at night, all of which can result in drying out of the eye. This can result in constant irritation, pain, discomfort, and a potential risk for infection and even loss of the eye.

Dr. Zoumalan has extensive experience in managing patients with facial nerve palsies that affect the eyelid. There are various techniques that can be employed in addressing the eyelids. If there is a weakness in the upper lid, a gold or platinum weight can be placed inside the eyelid to allow for better closure. The weight is implanted in the deeper eyelid structures in order to allow for the best cosmetic result. The lower lid often needs to be resuspended as well(with or without a midface elevation or SOOF lift) to allow for better closure of the lids. Dr. Zoumalan often works alongside a facial plastic surgeon in performing these techniques, while addressing the remaining deficits in the face (e.g. brow ptosis, facial reanimation surgery).

facial_nerve_palsy_eyelid

Preoperative Diagnosis: Left sided facial nerve palsy. Note the inability to raise the left brow. He also has a red and painful left eye due to his inability to close his eyelids. This is resulting in exposure keratopathy and an early corneal abrasion. If left untreated, the corneal abrasion can result in an infection which can result in serious complications, including potential loss of the eye.

facial_nerve_palsy_eyelid_lagophthalmos_difficulty_closing_eyelid

Upon closing his eyelids, he has an inability to properly close his left eyelids. As a result, he has exposure of his left eye. The eye is exposed to air and results in extreme dryness. This is called lagophthalmos. If left untreated, this can result in corneal abrasions and even infections.

image

Procedure performed: Placement of gold weight in the left upper eyelid and left lower lid canthoplasty. He is only 10 days out, but you can see he is able to close his lids better with resolution of his lagophthalmos. Note that Dr. Zoumalan is able to properly place the gold weight so that it is not visible or protruding from the eyelid as a visible mass.

 

  • iamge

    Preoperative Diagnosis: Right upper and lower lid retraction from facial nerve palsy and difficulty closing right eye.

    Procedure performed: Placement of gold weight in right upper eyelid, lower lid resuspension using canthoplasty and hard palate tissue graft to lower lid, and midface resuspension (SOOF lift).

  • iamge

    Preoperative Diagnosis: Left lower lid retraction from facial nerve palsy and difficulty closing left eye.

    Procedure performed: Left lower lid reconstruction using canthoplasty and tissue graft to lower lid as a posterior spacer.