Facial Paralysis Case Studies

Case Study No. 1

A 42-year-old gentleman presented to our skull base unit three years after increasing left-sided facial weakness, which culminated in complete left-sided facial paralysis and increased hearing loss.

The patient’s chief complaints were left eye dryness and irritation, asymmetry of the face, occasional drooling of fluids, and hearing loss. Exam revealed a dense left-sided facial paralysis and the inability to close the left upper eyelid.

CT and MRI studies suggested schwanoma involving the vertical portion of the facial nerve in the mastoid.

In addition to insertion of a gold weight into his left upper eyelid and, he underwent removal of large schwanoma from the descending portion of his facial nerve on the left necessitating resection of a portion of the facial nerve. This was followed by left midface reanimation using a free partial gracilis muscle transfer coapted to his left masseteric nerve.

At his 22-month follow-up, he demonstrates good voluntary control of his smile, improvement of symmetry in repose, and improvement during eating.

Case Study No. 2

A 71-year-old lady was diagnosed with a left acoustic neuroma 19 years prior to presentation at UTSW. At the time of her initial diagnosis she was treated with radiation and developed left facial paralysis. She had no eye protection at the time and lost her vision within six months of radiation. Her original complaints included oral incompetence, facial asymmetry, and inability to smile.

Five months after muscle transfer, the patient noted movement. More than 3 years after surgery she reports resolution of oral incompetence and greatly improved symmetry at rest and while smiling.

Case Study No. 3

This 32-year-old lady presented with partial right-sided facial paralysis and ocular-oral synkenesis. During her 8 months of pregnancy, she became completely paralyzed in the right face associated with severe right ear pain. She was diagnosed with Ramsay Hunt Syndrome and subsequently partially recovered motion in her face. She initially underwent insertion of a gold weight in the right upper eyelid in a post-septal position and 2 years later underwent facial reanimation of the right face with a muscle transfer.

Case Study No. 4

This 57-year-old lady, who served three tours in Afghanistan, presented with a 6-year history of partial recovery from Bell's Palsy. One of her major concerns was the inability to effectively produce a smile on the left partially paralyzed side of her face. She underwent a one-stage facial reanimation procedure and is presented here 4 months after surgery.

Case Study No. 5

This 50-year-old gentleman presented after surgical resection of squamous cell carcinoma of the skull base followed by radiation therapy. He had complete right facial palsy and inability to close the right eye. He initially underwent loading of the right upper eyelid with a gold weight followed by facial reanimation with muscle and nerve transfer to the right face to assist with symmetry and smile.

Case Study No. 6

This 29-year-old gentleman presented with increasing loss in balance and facial weakness on the left side. Imaging demonstrated a skull base tumor involving the area of the facial nerve, which had to be resected during surgery. He did well after his skull base surgery but because the nerve had to be sacrificed he had a dense left sided facial palsy and needed protection of the left eye. He underwent loading of the left upper eyelid with a gold weight and several nerve transfers to restore some of his facial motion.