Treating a paralyzed face with a nerve transfer

March 18, 2013 2:32:15 PM PDT
The muscles on each side of our faces are controlled by the facial nerve. When it's damaged, that side of the face is paralyzed. In some cases, a nerve transplant or nerve transfer may be the answer.

It's called a transfer because the transplanted nerve comes from the patient's own body. There are a couple of situations where a nerve transfer can save a patient's appearance, and sometimes her career.

Pat hill has been a model for many years, but her career was jeopardized six years ago by a complication of facial surgery. Her left facial nerve was cut in several places.

"I was totally paralyzed on my left side. I couldn't blink my eye, so I became almost like a Picasso painting," Hill said.

Pat means she could not smile or move the left side of her face.

Her operation? A nerve graft taken from the length of her left leg to attach to the cut parts of her facial nerve. It's the sural nerve, which carries sensation from the top of the foot.

"If there's numbness on the top of your foot, but it gives you back the ability to move the face, that's a pretty good tradeoff," Dr. Peter Costantino of Lenox Hill Hospital said.

Dr. Costantino is director of the New York Head and Neck Institute at Lenox Hill. Transferring the sural nerve to pat's face took him five hours in the operating room.

The facial nerve leaves the brain and travels through the parotid salivary gland, and then branches out to control the muscles around the mouth, nose, eyes and the scalp.

Accidents are another cause of facial nerve injury, but the most common are tumors in the parotid salivary gland.

"A number of them are malignant and in the process of getting rid of the cancer, the nerve has to be sacrificed," Costantino said.

Her smile has a little ways to go, but Pat says she notices improvement even now, six years later, and she's back to modeling.

"My clients are super supportive and understanding and I'm just very glad to have met Dr. Costantino," she said.

Pat's surgery was done under an operating microscope with stitches one eight the width of a human hair. Dr. Costantino's colleagues at New York Head and Neck Institute also deal with voice issues, balance problems and facial birth marks and moles.