Facial Nerve Surgery

Facial Nerve Surgery/Procedures

Facial Nerve Surgery Patient 1


This patient was referred to Dr. Bhama by another facial plastic surgeon for facial reanimation. He underwent excision of a parotid cancer which required sacrifice of the facial nerve, resulting in complete facial paralysis. He also underwent post-operative radiation. Pre-operative photos are shown. Notice the asymmetry of the face at rest, including droopiness of the lower eyelid on the right side, medialization of the right nasal ala (distortion of the nostrils), droopiness of the oral commissure (tip of the mouth), and inability to smile. Options were discussed with the patient. Because of the patients history of radiation and sacrifice of facial arteries, gracilis free flap would have been more challenging, so the patient elected for static reanimation. Dr. Bhama performed lower eyelid tightening, and Drs. Bhama, Edwards and Shikary performed fascia lata suspension of the nasal valve, oral commissure, and nasolabial fold reconstruction using the patient’s own tissues from his thigh. Post-operative photos are shown. Note the substantial improvement in overall appearance at rest. The lower eyelid is more appropriately secured against the globe of the eye. The nasolabial fold is more prominent. The nostrils are now more symmetric, and the patient’s nasal breathing improved dramatically. His oral commissure (mouth corner) is more appropriately placed, and he is able to express emotion to others. He was very happy with the results of surgery.


Facial Nerve Surgery Patient 2


This patient presented to Dr. Bhama with a facial mass. Imaging and biopsies demonstrated a tumor of the parotid gland called pleomorphic adenoma. Options were discussed with the patient and she elected for parotidectomy. MRI images are shown to demonstrate the large parotid mass. Dr. Bhama performed parotidectomy with facial nerve dissection to remove the tumor. To avoid a large divot in the face following removal of the gland, Dr. Bhama reconstructed the defect using various techniques to advance surrounding tissue into the defect. The patient recovered beautifully and was very happy with results. She had absolutely no weakness of the facial nerve post-operatively, and was very happy with the appearance of the scar. On post-operative photos shown, notice she retains completely normal movement of the face, and has an inconspicuous scar. Also notice the contour symmetry in the cheek.


Facial Nerve Surgery Patient 3


This patient presented to Dr. Bhama with a history of left sided facial paralysis thought to be secondary to facial schwannoma versus Ramsey Hunt Syndrome. As a result of her facial nerve injury, she developed severe left sided facial synkinesis (involuntary movement of muscles restricting normal function). She complained of difficulty with smiling, difficulty breathing through her nose, excessive eye closure, and asymmetry at rest. Dr. Bhama trialed Botulinum Toxin Injections to help improve her function and appearance. She was very happy with the results, but once the effects of the Botox ® had worn off, she desired a more permanent solution. Dr. Bhama and Dr. Shikary performed a complex procedure called ‘highly selective facial neurolysis’ which entailed dissecting various branches of the facial nerve, isolating branches that activate undesirable movement, and transecting those branches. Three nerve branches were cut for this patient to improve her function. Additionally, the platysma muscle and depressor anguli oris muscles were transected to improve her oral commissure excursion (smile) on the left side. In the pre-operative photo at rest, notice the hypertonic left midface. The nasolabial fold is horizontally mal-oriented, and the oral commissure is elevated, even though the patient is not trying to smile. One week post-operative photos demonstrate substantial improvement in oral commissure position at rest, and in the orientation of the nasolabial fold. Her face appears more symmetric. When the patient smiles, she has improved dental show and oral commissure excursion. Because she is only one week post-op at this point, her movement is restricted by discomfort and tightness but will continue to improve as time goes on. She was very happy with the results thus far and noticed improvement in her smile, and overall facial function.


Facial Nerve Surgery Patient 4


This patient fell on a piece of glass and lacerated her cheek, resulting in injury to her parotid gland, facial muscles, and facial nerve. The cheek laceration was repaired in the emergency room, and she was seen by a facial plastic surgeon at another institution, who initially managed the patient and then referred the patient to Dr. Bhama for management of her facial weakness several weeks after the injury. The patient was bothered by her inability to smile on the right side. Dr. Bhama performed facial nerve exploration, scar revision, and repair of injured facial musculature. Pre and post-operative photos are shown. At rest, notice the improvement in oral commissure position and nasolabial fold depth. Her cheek scar has also improved in appearance. When smiling, the patient now has substantially more upper lip movement, resulting in improved dental show, and a more meaningful smile. She was very happy with results.


Facial Nerve Surgery Patient 5

Facial Nerve Surgery

This patient presented to Dr. Bhama with a left sided parotid gland mass. Dr. Bhama performed superficial parotidectomy with facial nerve dissection. Surgery went well and post-operatively, the patient had completely normal facial nerve function without any weakness. Shown is an early post-operative photograph demonstrating excellent movement in all zones of the face and an excellent facial contour. She was very happy with the result. Pathology revealed a pleomorphic adenoma.


Facial Nerve Surgery Patient 6


This patient presented to Dr. Bhama with left sided synkinetic facial paralysis following Bell’s Palsy. The patient complained of excessive eye closure, particularly when smiling on the left side, as well as neck tightness on the left side. On pre-treatment photos, notice the excessive left eye closure with smile. When the patient closes his eyes, notice the chin dimples and tension of the left side of the neck. He underwent chemodenervation of his facial muscles using botulinum toxin injection in clinic. The procedure took less than 2 minutes and was nearly painless. On post-injection photos, notice the dramatic improvement in eye closure with smile, and the improvement in chin dimpling and neck tightness when closing eyes. The patient was very happy with results and felt much better overall.


Facial Nerve Surgery Patient 7


This patient underwent left sided parotidectomy in 2004 with a different surgeon for a parotid tumor. She noticed a recurrent nodule in 2020 in the left cheek and was referred to Dr. Bhama for management. Dr. Bhama ordered a needle biopsy which demonstrated recurrent pleomorphic adenoma of the parotid gland. Dr. Bhama performed complex revision facial nerve dissection and parotidectomy. The tumor was adherent to branches of the nerve and meticulous dissection was required to avoid injury to the nerve. Post-operatively, she recovered well, and had completely normal facial nerve movement. Post-operative photos are shown here, demonstrating completely normal facial nerve function in all zones of the face. The patient was very pleased with the result.


Facial Nerve Surgery Patient 8


This patient presented to Dr. Bhama with difficulty moving the left side of her face from Bell’s Palsy. Options were discussed and the patient elected for chemodenervation using Botulinum Toxin and physical therapy. On pre-treatment photos, notice the droopiness of the left oral commissure, dimpling of the chin with eye closure, and weak smile. She underwent treatment with Dr. Bhama as well as physical therapy. On her post-injection photos, notice the improved oral commissure symmetry, improved mentalis (chin) dimpling, and improved smile. She was very happy with results.


Facial Nerve Surgery Patient 9


This patient was referred to Dr. Bhama for an enlarging right parotid (salivary gland) mass that had previously been infected and required inpatient treatment with IV antibiotics. On the CT scan, notice the large mass of the right parotid gland. Dr. Bhama performed parotidectomy and facial nerve dissection. The mass was found to be extending through the platysma muscle in the neck into the subcutaneous fat and was densely adherent to the facial nerve (the nerve that controls facial movement). Removal resulted in a large cavity of the face, and Dr. Bhama performed reconstruction of the defect using a SMAS (superficial musculoaponeurotic system) flap. Early post-operative pictures are shown demonstrating completely normal facial movement, and an excellent facial contour. The scar will continue to improve with time. The patient was very happy with results.


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