The Center for Facial Reconstruction at the New York Head and Neck Institute of North Shore-LIJ Health System provides state-of-the-art procedures to reconstruct and improve the appearance of patients affected by deformities of the face or skull bones (craniofacial reconstruction) and paralysis of the facial nerve. The facial nerve supplies the muscles of the face, enabling us to smile, frown, close our eyes and move our mouths.
The Center's surgeons are of national stature in procedures of craniofacial reconstruction, and it has attracted a talented staff in all aspects of this challenging area of head and neck surgery. Our excellence in the field of facial reconstruction was recently represented when the Center’s surgeons were among the few in the country to perform facial transplant surgery. The approval process subjected the Center and its entire staff to intensive review by multiple hospital regulators, organ donor networks and state regulators.
A Collaborative Approach
In addition to nationally ranked facial reconstructive surgeons, the Center brings together several other medical professionals, such as:
- Radiologists who are experts in the interpretation of imaging studies of these complex areas
- Psychological professionals to care for the severe loss of self-esteem that can result after a disfiguring event
- Speech-language pathologists in the non-surgical aspects of facial and craniofacial rehabilitation
We believe that this holistic approach across many different specialists streamlines the diagnosis and treatment of facial nerve disorders and cranial facial defects, offering our patients first-rate care in a thorough and compassionate manner. This approach often results in a faster and less complicated recovery with less stress to the patient.
Frequently Asked Questions
What services does the Center for Facial Reconstruction offer?
What is the facial nerve?
- Facial Nerve Paralysis Rehabilitation Program (the facial nerve controls the muscles of expression on one side of the face. Facial nerve paralysis leaves one side of the face flaccid with the inability to close the eye and mouth on that side resulting in damage to the eye from drying and drooling)
- Advanced Cutaneous Laser Program (treatment of the skin for defects with a laser beam)
- Biomaterials Implant Program (any biological material implanted, usually for defects of the facial and cranial skeleton)
- Craniofacial Skeletal Contouring (making the skull and face more normal in shape)
- Facial Soft Tissue and Scar Reconstruction
- Moh’s Defect Reconstructive Surgery (defects left after a special method of skin cancer removal that preserves as much normal tissue as possible)
- Microsurgical Nerve and Tissue Transfer (using a microscope to graft nerves and muscles from one part of the body to another)
- Nasal Reconstruction (surgery to open the nose so that normal breathing through the nostrils is restored, often needed after nasal trauma or facial nerve paralysis)
- Orbital (eye socket) and Eyelid Reconstructive Surgery
- Psychological and Occupational Support
- Speech and Swallowing Therapy
What is facial paralysis?
The facial nerve is one of the large nerves arising from the base of the brain that exits the skull base in front of the ear. It is one of the nerves that control special functions such as seeing, hearing, smell and swallowing and controls the muscles that supply movement to the face. The facial nerve also carries nerve fibers that are responsible for taste for the front 2/3 of the tongue, as well tearing from the eye. A drawing to the right shows its main division after it exits the skull base.
What are the effects of facial nerve paralysis?
Facial paralysis is the loss of function of the 7th cranial nerve that results in total or partial loss of the movement of the muscles of the face. Decreased taste and problems with tearing can also occur with facial paralysis.
What are the causes of facial nerve paralysis?
Facial paralysis can lead to less intelligible speech, drooling and difficulty eating, incomplete closure of the eye with exposure of the cornea and cosmetic deformity. For instance, with a facial paralysis, one side of the face does not move when smiling, much like you see with a victim of a stroke.
How is the severity of facial nerve deficit determined?
- Bell’s palsy (cause of paralysis not known, named after Dr. Bell who first described it)
- Herpes infection (viral infection with the virus causing cold sores)
- Ear Infection
What non-surgical treatments are available for facial paralysis?
There is a grading system that assists the physician in categorizing the extent of the nerve deficit.
I Normal Movement.
II Mild Dysfunction: Gross slight weakness, normal tone of the muscles, asymmetry (difference in function between the two sides of the face) limited to mouth.
III Moderate Dysfunction: Obvious but not disfiguring asymmetry, weak forehead, asymmetric mouth, eye closure with effort.
IV Moderately Severe Dysfunction: Obvious weakness and/or disfiguring asymmetry. Good tone at rest. No forehead movement, incomplete eye closure, asymmetric mouth.
V Severe Dysfunction: Only barely perceptible movement, rest asymmetry. Mouth and eye only slight movement without eye closure.
VI Total Paralysis: No movement, gross asymmetry.
What are the types of surgical treatments available?
- Medications such as steroids
- Observation in specific circumstances
- Facial movement physical therapy with neuromuscular retraining
- Medical eye care
- Speech therapy
- Botulinum toxin (Botox©) Injection (done on the normal side of the face making it weaker so it appears more like the paralyzed side)
- Soft tissue fillers (material injected under the skin to "plump up" the paralyzed side of the face)
What are the static surgical procedures?
Static procedures are those that lift the face to a more neutral position, but do not provide movement to the face. They are essentially a face lift of the tissues around the eye and mouth to prevent drying of the eye and drooling due to facial nerve paralysis.
Dynamic procedures are those that also lift the face and they provide movement to the face. These procedures are grafting of other nerves onto the facial nerve or transferring other muscles with their nerves working into the paralyzed side of the face to restore muscle function to an area. Again, it is often used around the eye and mouth after facial nerve paralysis.
What are the dynamic (restoring movement) surgical interventions?
- Upper eyelid gold weight placement (the weight of the gold leaf forces the upper eyelid down helping to protect the eye from drying)
- Lower lid tightening (corrects lower lid droop due to muscle laxity and helps to protect the eyeball from drying)
- Minimally invasive browlift suspension (surgery using a small fiberoptic telescope placed through an incision in the eyebrow or in the hairline to lift the brow on the paralyzed side to make the face appear more normal)
- Lower facial suspension (a facelift of the lower part of the face on the paralyzed side to stop drooling)
- Upper lid spring implantation (a small spring to keep the upper lid to aid eyelid closure on the paralyzed side, to prevent drying of the eye)
- Lower lid sclera graft placement (a graft of tissue to the exposed inside of the lower eyelid when to prevent drying of the eyeball)
- Nasal alar repositioning-surgically moving the small cartilages (alar cartilages) supporting the outsides of the nostrils to restore normal nasal breathing through the nostril on the paralyzed side which collapses on breathing in when the facial nerve is paralyzed
- Reconstructive Rhytidectomy (Facelift)
- Temporalis muscle transfer (moving a part of the muscle on the side of the head that closes the jaw so by clenching the jaw the patient can lift the forehead on the paralyzed side of the face)
- Hypoglossal-facial nerve grafting (using a part of the cranial nerve controlling the tongue which then grows into the paralyzed nerve bringing back nerve function)
- Crossface Facial Nerve to Facial Nerve Grafting (grafting branches of the opposite normal facial nerve to the paralyzed nerve to provide nerve impulses to the muscles of the paralyzed side)
- Ansa Cervicalis facial nerve grafting (grafting a small nerve that controls muscles in the neck to the paralyzed facial nerve to restore function)
- Interposition facial nerve grafting (grafting a nerve from somewhere else in the body between the stumps of the facial nerve on the paralyzed side)
- Microvascular muscle nerve transfer (using a high magnification microscope, a muscle and the nerve that makes it function are grafted into the muscles on the paralyzed side)