Facial paralysis is a severe functional and aesthetic disability. Those who suffer from it will be familiar with this description as well as the topic of facial reanimation. Simply
put, the facial nerve on one side of the face is put out of action. It has a number of causes: specifically Bell’s palsy; stroke; surgery for acoustic neuroma, and facial trauma –
surgical or otherwise. There are also genetic and congenital causes. The paralysis causes a severe facial droop; inability to close the eye properly (resulting is watering and inflammation); a lopsided smile and occasionally drooling due to a lack of oral continence. Facial reanimation is the correction of facial paralysis and is often accompanied by other procedures aimed at restoring facial symmetry and protecting the eye.
‘Smile surgery’ is the reanimation of the mouth so that the patient not only regains oral symmetry, but also is able to smile, and properly assist in social interaction. Patients with
facial paralysis are severely self-conscious, embarrassed and reluctant to mix socially: they become reclusive. Restoration of the smile breaks down this self-imposed barrier and permits them to reintegrate with their family, friends and workmates so they may live and work a ‘normal life.’ The dramatic effect of this operation cannot be over stated. Other measures include the placing gold weights in the upper eyelid to assist eye closure, and the direct excision of skin to correct brow droop; but the restoration of smile is the centerpiece and the major technical challenge of surgery for facial paralysis.