Otolaryngology

Facial Nerve Disorders

The team at the UI Health Facial Nerve Multidisciplinary Center understands how the loss of facial movement can have a significant impact on an individual's well-being. The treatment of facial paralysis is extremely specialized and requires dedicated training and expertise. Our goal is to provide excellent comprehensive care and treatment to restore self-confidence and improve quality of life.

Our Multidisciplinary Team covers the breadth of medical and surgical services, and our complementary expertise addresses all aspects of facial nerve problems.

Facial nerve disorders may cause:

• Weakness
• Paralysis
• Involuntary movement
• Tearing
• Twitching or drooping of the facial muscles

It can also have a substantial effect on speech, vision, eating, drinking and the ability to express emotion. The most common cause of facial paralysis is Bell's palsy, which is thought to be a viral infection of the facial nerve, although the exact cause is not well known. Other causes of facial nerve paralysis include head trauma, parotid tumors, head or neck cancers, infections, brain tumors or stroke. The onset of facial paralysis can be sudden or gradual depending on the cause.

Because facial nerve problems have multiple sources and symptoms, an approach involving experts from many clinical areas provides the most effective means of addressing these conditions. The Facial Nerve Multidisciplinary Center provides specific, superior care and compassionate support for patients with facial nerve disorders. Our combined medical and surgical expertise allows us to help patients improve their non-verbal communication, appearance, facial function, and overall well-being. We offer a full range of facial paralysis treatments, including conventional and innovative therapies and advanced surgical techniques. We work together to deliver individualized treatment plans to suit each patient's specific condition. We look forward to taking care of you!

Diagnosis:
An initial meeting begins with an assessment. The physician will ask the patient to move various facial muscles: smiling/frowning or raising eyebrows to determine the extent of the facial nerve issue. Other tests and scans may be done to assess the health and strength of muscles and nerves controlling them. If the cause of your facial nerve paralysis or disorder is unknown, your doctor may recommend additional tests, including:

• Electromyography (EMG): An EMG measures a muscle's electrical activity when stimulated and how fast the muscle responds. This test is used to confirm nerve damage and determine its severity.
• CT or MRI scans: These tests can help determine other causes of facial nerve damage, such as a fracture, infection, or tumors in the head or neck area.

Treatment:
Treatment of facial nerve disorders varies based on the cause and severity of the condition. Facial nerve paralysis that does not have an identifiable cause (Bell's Palsy) may go away on its own, but it does require careful watching by you and by your physician.  In some cases, steroids or antiviral medicine can promote recovery. Some patients may use physical therapy to recondition and strengthen affected muscles, and for some who do not recover fully, facial plastic surgery may help.

Facial nerve damage from a stroke may be helped by medications treating other stroke symptoms. Other causes and symptoms of facial nerve damage may benefit from surgery if nerves or muscles are damaged. Sometimes physical therapy or Botox injections are used to decrease the activity of the affected muscles in patients who experience twitching or involuntary movements of the face.

Procedures performed for the management of facial paralysis may include:

Facial Retraining

UI Facial nerve physical therapists work with you to develop customized movement patterns that help you re-coordinate the muscles of your face after paralysis. Facial retraining is a non-surgical approach to rehabilitation in which you and a therapist identify the facial muscles that are functioning incorrectly and create strategies to re-establish normal function as much as possible.

Facial Reanimation

For paralysis that recovers partially, or not at all, there are a wide variety of treatments, both medical and surgical, that are aimed at dealing with existing paralysis. The goals of reanimation include the restoration of symmetry, movement, and function. Treatments are tailored toward the patient, with careful consideration of the etiology (cause) and also the patient's long-term outcome goals. The procedures offered at UI include eyelid and eyebrow surgery, nasal surgery, facial suspension, nerve grafts, and gracilis muscle and nerve transfers. 

We treat a large volume of complex cases, and we provide second opinion services for patients who have recent, delayed, or long-standing facial paralysis.

Meet Our Multidisciplinary Team

We cover the breadth of medical and surgical services, and our complementary expertise addresses all aspects of facial nerve problems. Including:

Audiology
Dr. Nichole Suss performs our highly specialized ENoG testing.

Contact Lens and PROSE specialist
Dr. Ellen Shorter is the Director Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Clinic which specializes in bandage lenses and prosthetic device fitting to improve comfort and vision. For people with facial paralysis, PROSE treatment can reduce blurry vision, help keep what is seen sharper, and prevent damage to the cornea.

Electrophysiology
Dr. Charles Abrams specializes in electrophysiology and the evaluation of the function of the facial nerve. This team uses EMG-facial motor studies and blink reflexes to determine if the lesion is demyelinating or axonal, which affects diagnosis (demyelinating is more likely to heal on their own) and can help with localization.

Facial Reanimation Surgery
Dr. Tatiana Dixon is a facial plastic surgeon specializing in restoring facial function using a variety of static and dynamic techniques.

Neurotology and Facial Nerve Canal Surgery
Our team specializes in surgery of the facial nerve, ear, and skull base.

Neurosurgery
Dr. Fady Charbel, Chair of Neurosurgery, specializes in removing the intracranial tumors relating to the facial nerve.

Neurology
Dr. Zulma Hernandez-Peraza and Dr. Fernando Testai are neurologists caring for most of the University's facial nerve paralysis patients.

Oculoplastics and Neuro-ophthalmology
Dr. Vinay Aakalu and Dr. Peter Macintosh focus on recreating a natural looking eye with a natural blink.

Physical Therapy and Facial Nerve Rehabilitation
Dr. Anita Sanchez specializes in diagnosing the exact muscles of the face which are weak, and then addressing them. She has developed her own facial exercise system for her patients.

Plastic & Reconstructive Surgery
Dr. Lee Alkureishi specializes in restoring facial symmetry and muscle function. His practice provides a full complement of microsurgical and cosmetic solutions ranging from nerve grafting and transfer to simple static procedures to camouflage imbalance.

Psychology
Dr. Janine Rosenberg provides evaluation and treatment of the social and emotional impact and adjustments for patients with facial paralysis.

Speech Pathology:
Dr. Kimberly Zimmerman, CCC-SLP, Director of Speech Pathology and Hospital Neurosciences, manages the Speech Pathology staff providing motor speech and swallowing assessment and treatment for patients with facial weakness. The speech pathology team individualizes each patient's situation to develop compensatory strategies for speaking and swallowing.

For More Information, call 312.996.6269