Conditions that we diagnose and treat at the UPMC Facial Nerve Center include:
- Synkinesis
- Bell’s palsy
- Ramsay Hunt syndrome
- Lyme disease
- Vestibular schwannoma
- Facial nerve trauma
- Cancer-associated facial paralysis
- Congenital facial paralysis
Synkinesis
Non-flaccid facial paralysis, or synkinesis, refers to a subcategory of facial paralysis characterized by muscle tightness, disorganized muscle movements, and an inability to make normal facial expressions. Some patients describe feeling as if their face is “frozen.” Patients with synkinesis often note facial asymmetries including inability to raise their eyebrow, narrowing of their affected eye, dimpling of the chin, and inability to smile. They also can experience functional issues including uncomfortable muscle pulling and tightness, especially in the neck, as well as difficulty articulating and drinking out of a straw. The severity of these symptoms can range from mild to debilitating. Synkinesis can occur after a transient insult to the facial nerve, such as after an episode of Bell’s palsy or Ramsay Hunt syndrome. Symptoms typically do not resolve spontaneously, but many different treatment options exist to improve the symptoms and asymmetries associated with synkinesis.
Here at the UPMC Facial Nerve Center, we believe in a tiered, multidisciplinary approach for the treatment of synkinesis. At your initial consultation, Dr. Yver will discuss your concerns and help to develop a customized, patient-centered treatment plan. This may include physical therapy, Botox or filler, minor office procedures, or various surgical interventions.
Treatment options for synkinesis include:
- Facial nerve physical therapy
- Chemodenervation (Botox) therapy
- DAO myectomy
- Functional upper blepharoplasty
- Brow lifting
- Selective denervation
- Gracilis free muscle transfer
Bell’s Palsy
Bell’s palsy is a sudden onset, complete facial paralysis that typically occurs over 24 – 48 hours. Sometimes, this can be associated with ear pain or taste disturbances on the affected side. It is thought that Bell’s palsy is caused by a reactivation of a virus lying dormant in the cell body of the facial nerve. Bell’s palsy is a diagnosis of exclusion, meaning that it is important to rule out other possible causes of facial paralysis.
Patients experiencing new-onset Bell’s palsy should seek medical attention through a primary care doctor, an emergency care provider, or an otolaryngologist. The recommended treatment includes a course of steroids and anti-viral medication.
Spontaneous recovery of facial function is nearly always observed after an episode of Bell’s palsy; the timeline for recovery typically ranges from 1 week up to 4 months after onset. Many patients recover to baseline facial function; however, up to 45% may experience some long-term synkinesis following Bell’s palsy.
At the UPMC Facial Nerve Center, you will be evaluated by a specialist who has experience treating Bell’s palsy. Your recovery is documented with serial photographs, and your case is carefully reviewed to ensure adequate treatment and rule out other etiology of facial paralysis.
Treatment options for synkinesis following Bell’s palsy include:
- Facial nerve physical therapy
- Chemodenervation (Botox) therapy
- DAO myectomy
- Functional upper blepharoplasty
- Brow lifting
- Selective denervation
- Gracilis free muscle transfer
Ramsay Hunt Syndrome
Ramsay Hunt syndrome is a sudden onset, complete facial paralysis often associated with hearing loss, vertigo, or a characteristic rash involving the face or ear. Like Bell’s palsy, Ramsay Hunt syndrome is caused by the reactivation of a virus that lies dormant in the cell bodies of the facial nerve (varicella zoster, also known as the shingles virus).
Patients experiencing new-onset Ramsay Hunt syndrome should seek medical attention through a primary care doctor, an emergency care provider, or an otolaryngologist. The recommended treatment includes a course of high-dose steroids and anti-viral medication.
Spontaneous recovery of facial function is nearly always observed after Ramsay Hunt syndrome; the timeline for recovery typically ranges from 1 week up to 6 months after onset. Many patients recover to baseline facial function; however, some may experience long-term synkinesis. At the UPMC Facial Nerve Center, you will be evaluated by a specialist experienced in treating Ramsay Hunt syndrome. Your recovery is documented with serial photographs, and a hearing test may be obtained if indicated. Your case will be carefully reviewed to ensure adequate treatment and rule out other etiology of facial paralysis.
Treatment options for synkinesis following Ramsay Hunt syndrome include:
- Facial nerve physical therapy
- Chemodenervation (Botox) therapy
- DAO myectomy
- Functional upper blepharoplasty
- Brow lifting
- Selective denervation
- Gracilis free muscle transfer
Lyme Disease
Lyme disease is a bacterial, tick-borne illness caused by the bacterium Borrelia burgdorferi. It is a common cause of facial paralysis in certain regions of the United States. Lyme disease is particularly prevalent in Allegheny County and represents the most common cause of bilateral facial paralysis. New-onset facial paralysis related to Lyme disease is commonly associated with systemic symptoms such as headache, fatigue, muscle pains, and chills.
When treated promptly with antibiotics, facial paralysis due to Lyme disease has an excellent prognosis. Many patients recover to baseline facial function; however, some may experience long-term synkinesis. Your history will be reviewed in detail at the UPMC Facial Nerve Center, and appropriate Lyme disease testing will be ordered if indicated.
Treatment options for synkinesis following Lyme disease include:
- Facial nerve physical therapy
- Chemodenervation (Botox) therapy
- DAO myectomy
- Functional upper blepharoplasty
- Brow lifting
- Selective denervation
- Gracilis free muscle transfer
Vestibular Schwannoma
Vestibular schwannomas are benign tumors of the vestibulocochlear nerve (8th cranial nerve), which controls hearing and balance. Vestibular schwannomas rarely cause facial paralysis, but they can cause hearing loss or symptoms related to compression of the brain if they become particularly large. Because the vestibulocochlear and facial nerves are closely intertwined, surgery to remove a vestibular schwannoma can sometimes result in transient or permanent facial nerve weakness or palsy. A small subset of patients may wake up from vestibular schwannoma surgery with facial weakness; this may or may not improve depending on whether the nerve is intact at the end of surgery. Some patients who experience the return of facial function following the removal of a vestibular schwannoma can develop synkinesis.
The providers at the UPMC Facial Nerve Center have extensive experience treating patients with facial weakness related to vestibular schwannoma. Treatment options can include eyelid weight, lower lid tightening, nerve transfer procedures, treatments for synkinesis, and even free muscle transfer. At the UPMC Facial Nerve Center, your unique case will be carefully reviewed to develop a customized treatment plan.
Facial Schwannoma
Facial schwannomas are benign tumors of the facial nerve (7th cranial nerve), which controls facial function. They can be asymptomatic, but in some cases, they can cause either progressive or fluctuating facial weakness. If there is concern for a facial schwannoma, your provider will likely order imaging (a CT or MRI scan). Providers must maintain a high index of suspicion for facial schwannoma, as they can be challenging to pick up on imaging.
Multiple treatment options exist for facial schwannomas, including observation, surgical removal, nerve grafting, or radiation. In cases where symptoms are likely related to compression of the nerve, surgical decompression of the facial nerve may be indicated. Facial schwannomas can cause progressive facial paralysis, recurrent facial paralysis, or synkinesis. The UPMC Facial Nerve Center multidisciplinary team has extensive experience treating patients with facial weakness related to facial schwannomas. Your case will be carefully reviewed to develop a customized treatment plan, including treatment of the schwannoma and facial reanimation options.
Facial Nerve Trauma
Trauma to the facial nerve can result from blunt facial trauma, penetrating facial trauma, or surgery. Depending on the extent of the nerve injury, this can result in flaccid facial paralysis (for example, if the nerve is severed) or synkinesis (recovery after a transient injury). Conservative management with close observation may be indicated if the nerve is anatomically intact. If there is concern that the nerve has been cut or transected, a nerve exploration with primary repair or a nerve graft may be indicated. Patients with traumatic nerve injury may also benefit from adjuvant interventions, such as maneuvers to protect the eye, static suspension techniques, nerve transfers, or gracilis-free muscle transfer.
Cancer-associated Facial Paralysis
Because of its complex anatomy, the facial nerve can be involved in various cancers of the head and neck. Skin and salivary gland cancers are the most common cancers affecting the facial nerve. Facial paralysis may result from direct invasion of the nerve by the cancer or surgery indicated to remove the cancer. Facial nerve injury from head and neck cancer can result in flaccid facial paralysis or synkinesis, depending on the extent of the nerve injury. Our team at the UPMC Facial Nerve Center, which includes head and neck surgical oncologists and facial reconstructive surgeons, has extensive experience treating these types of cancers and devising a comprehensive facial reconstruction and reanimation plan.
Congenital Facial Paralysis
Congenital facial paralysis refers to facial paralysis or weakness that has been present since birth. It can range from complete facial paralysis to zonal or partial facial weakness. Congenital facial paralysis can be associated with congenital conditions such as Mobius syndrome, CHARGE syndrome, Goldenhaar syndrome, and congenital unilateral lower lip palsy.
Patients with congenital facial paralysis may be candidates for a range of facial reanimation options, from chemodenervation for facial balancing to gracilis-free muscle transfer. The physicians at UPMC Facial Nerve Center are affiliated with the Children’s Hospital of Pittsburgh in an effort to deliver the highest quality of care to patients with congenital facial paralysis.