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acial expressions can be con- the face. Static procedures include weighting
sidered the ultimate universal the eyelid with gold or platinum weights to
language, as they are a non-ver- assist with closure. The lower eyelid can be
bal way of communicating that tightened to help improve eye health. Addiis understood globally. We interact, perceive, tionally, the face can be lifted using a fascial
and communicate with the world through band from the leg to improve symmetry of
facial expressions and emotions. The facial the face and mouth and improve the oral
nerve is responsible for controlling the function, or procedures to help breathe
muscles of facial expressions. With loss of through the nostril may be performed.
function of this nerve there will be paralysis
In order to improve facial movement
or weakness of the face. Unilateral facial and function, facial reanimation using
nerve palsy occurs in approximately 25 out nerve grafts, borrowing nerves to other
of 100,000 people. This paralysis will present muscles, or bringing in new muscle can be
with facial droop, appearing as a one-sided performed. Facial muscles remain healthy
smile or an eye that resists to closing. Bilat- for approximately 18 months before atrophy.
eral facial nerve palsy is extremely rare and If facial reanimation surgery is performed
represents less than 2% of all facial palsy before this, the facial muscles can be reincases.1 Facial nerve paralysis can be caused nervated and will start working again. This
by congenital defects, Lyme disease, other involves connecting the facial nerve on
infections, trauma, stroke, tumors, or by the functioning side to the muscles of the
idiopathic, or unknown, reasons.
nonfunctioning side or bringing in another
Facial nerve disorders come with cos- nerve to stimulate the face. If the surgery
metic, functional and psychological issues, occurs later than the 18 month mark, a
seriously impacting the quality of life for muscle transfer can be used, which involves
patients. There is a significant impact on placing a muscle from a different part of the
facial function. This includes decreased body into the face, and connecting it to either
ability to maintain eye health and vision the normal functioning facial nerve on the
by not being able to close the eye, tearing other side of the face or another nerve in
of the eye, nasal obstruction by collapse of the region (for example the nerve that goes
the nostril, and issues with oral competency to the masseter muscle).
affecting one's ability to speak clearly or
Unfortunately, many patients may be
keep food in the mouth. The psychosocial unaware of the possibility of regaining
impact of facial paralysis may be severe for function of their facial muscles. This was the
some. For example, facial nerve paralysis situation for Mary, when she first came to
patients are more likely to struggle with the Multidisciplinary Facial Nerve Disorders
depression.2 Due to the lack of function of Clinic in Hershey.
the patient's facial muscles, they have speech
Mary's story of facial nerve paralysis began
difficulties, making it challenging to socialize
1992, when she noticed a change in her
with others. They may have difficulty eating
She picked up the phone one day
or drinking water, and have uncontrolled
there was a bad connection,
drooling. Because of this, many patients
the phone on the other
with facial nerve disorders refrain from social
She said her hearing
situations and are less involved with their
where her husband
community. In extreme cases, this may lead
of her, talking to
to social isolation. Due to loss of the ability
to close the eye, patients with facial nerve
palsy are at higher risk of corneal abrasions
Mary was diagnosed with a vestibular
and other vision issues.3
schwannoma, which is a benign tumor
Static reconstructive procedures can be located between the inner ear and the brain.
performed to improve physical appearance She received treatment for the schwannoma,
and function for patients with a facial nerve but shortly after treatment she noticed facial
disorder but will not increase function of weakness. Mary had a total facial paralysis

of the right side, meaning she could not use
any of the muscles on that side of her face,
and had a facial droop. She was unable to
move her eyebrow, eyelid, and right side
of her mouth. Due to the lack of muscle
innervation she lost her ability to breathe
out of her nose as well.
Similar to many other facial paralysis
patients, Mary found herself becoming
more socially isolated. She went through
multiple static surgeries over the years to try
to improve her symmetry and function, but
these did not improve her facial motion. Her
ability to smile, talk, eat and drink continued
to be limited, leading to decreased quality of
life, decreased interest in social interactions,
and a lack of confidence.
When Mary first found Dr. Jessyka
Lighthall, a facial plastic and reconstructive
surgeon, at Hershey Medical Center it was
because her eyelid weight from a previous
surgery was coming out through the thin
eyelid skin, causing irritation. Dr. Lighthall
founded and directs the multidisciplinary
Facial Nerve Disorders Clinic at Penn State
Hershey Medical Center. Dr. Lighthall
told her she could help her with her eyelid
weight, but also discussed options to give her
function back to the right side of her face.
Mary was moved to tears. She had undergone multiple surgeries and appointments
with physicians, but never knew that regaining function was even an option. She knew
this surgery had the potential to change
her life. Shortly after this appointment she
underwent a two-staged facial reanimation
surgery with Dr. Lighthall and Dr. Cathy
Henry, a plastic and reconstructive surgeon,
to bring new muscle from her leg to her face
as well as new nerves to stimulate it (Figure 1).
While facial reanimation surgery can
improve facial appearance and function,
the road to recovery after surgery can be
long. Mary met with the facial rehabilitation
specialists, Nicole Fisher and Sue Keener,
from the clinic for therapy where she learned
exercises to practice in order to regain facial
function. In a way, patients have to re-learn
how to move their face by using different
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Central PA Medicine Fall 2020

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