The USC Facial Nerve Center offers patients access to a world-class team of experts dedicated to facial nerve rehabilitation. By combining physician leaders from multiple specialties, patients are afforded unparalleled access to national leaders in the diagnosis and treatment of facial nerve disorders.
Participating services include Facial Plastic and Reconstructive Surgery, Neurotology, Neurosurgery, and Physical Therapy. Patients have access to a broad array of diagnostic and treatment options, including surgical and non-surgical treatment for a variety of facial nerve disorders.
Our mission is to deliver seamlessly integrated and patient-centered treatment for all disorders affecting the movement of the face.
Your face is the instrument through which you communicate with the world, and it is how the world sees you. Facial dysfunction is not only a complex clinical problem, but also a highly personal struggle for many of our patients. It is best treated by a team of experts who work together seamlessly on a routine basis. Our philosophy is that you deserve an integrated team of experts who are singularly committed to the restoration of facial function.
The USC Facial Nerve Center offers unparalleled surgical treatment for facial paralysis and facial spasm. Importantly, our surgical treatment is integrated with our non-surgical services. We offer access to neuro-diagnostics that can help to determine the likelihood of recovery without surgery. If surgery is required, physical therapy is an essential addition to mastering the restored movement of your face.
As an academic center of excellence, we seek to advance the care of facial dysfunction through cutting edge research. Clinical research and basic science (laboratory) research are therefore critical components of our mission.
Chronic Facial Paralysis
Facial paralysis is the loss of facial muscle movement due to a weakened or damaged facial nerve, usually occurring on one side of a patient’s face. Causes of facial paralysis or facial weakness include trauma to the face or skull, a tumor in the head and neck, among other causes. “Chronic” facial paralysis refers to long-standing weakness or immobility of the muscles of the face (for example, an inability to smile). In general, facial paralysis is considered “chronic” if it has lasted for longer than 1 year since initial symptom onset.
Acute Facial Paralysis
Acute facial paralysis describes weakness of immobility of the muscles of the face that has lasted for less than 1 year. The most common cause of acute facial paralysis is Bell’s palsy (see below).
Bell’s Palsy (Idiopathic acute facial paralysis)
Bell’s Palsy is thought to be due to viral inflammation around the facial nerve as it travels within the base of the skull. It is the most common cause of facial paralysis. Treatment of Bell’s Palsy involves taking a brief course of oral steroids, and may include an oral antiviral medication as well. Typically, patients who are promptly treated for Bell’s palsy recover full facial movement. After recovery from Bell’s Palsy, some patients may notice facial muscle spasms or facial discomfort. This may be a sign of synkinesis (see below) and is treatable. Certain patients with severe Bell’s palsy may benefit from facial nerve decompression surgery. The need for this surgery is determined by electrodiagnostic testing provided at the USC Facial Nerve Center.
Some patients who have had Bell’s palsy or other reversible forms of facial nerve injury may go on to develop synkinesis. This is a condition that causes unwanted contractions of the muscles of the face during attempted movement. Most commonly, patients will notice forceful eye closure when they attempt to smile, or other muscle spasms during routine facial movements. It is essentially a “faulty re-wiring” of the facial nerve that occurs after injury and recovery. It can be very distressing to patients and may significantly impact emotional expression and facial function. It may even cause facial discomfort or pain.
Facial spasm is a rare neuromuscular disorder characterized by involuntary and irregular muscle contractions or spasms on one side of the patient’s face. These spasms result from a normal artery that may compress the facial nerves as they pass through the cranial base.
Trigeminal neuralgia is an intensely painful neuropathic disorder that is characterized by episodes of severe pain in the face. This pain originates in the trigeminal nerve, another one of the nerves that pass through the cranial base.
Treatments and Services
Electrodiagnostic testing after facial paralysis to determine prognosis
Following any severe facial nerve injury, including Bell’s Palsy, it may be helpful to undergo electrodiagnostic testing in order to determine the prognosis for spontaneous recovery. Fine, sterile needle electrodes are used to determine the electrical activity of facial muscles, even when they are not able to move the face in a manner visible to a patient or observer. This is analogous to an electrocardiogram (EKG) that is used for the muscles of the heart. Similarly, facial electrodiagnostic testing can provide valuable clinical information that may guide treatment. This testing is best performed and interpreted by an integrated team of providers who can work together to accurately interpret the results and craft an appropriate treatment plan.
Physical therapy for facial paresis and synkinesis
Facial neuromuscular retraining is the name given to a specialized form of physical therapy that is unique to facial dysfunction. Specialized therapists educate patients in appropriate exercises and a treatment regimen to maximize their desired facial movement. This is often an importantaddition to many forms of facial nerve paralysis treatment, both surgical and nonsurgical.
Nerve transfer surgery for facial paralysis
In cases of facial nerve paralysis that have lasted, in general, 1 year or less, a nearby motor nerve can be connected to a portion of the facial nerve in order to restore movement. The most common of these procedures is called the Nerve to Masseter Transfer. This involves the use of the nerve to the masseter muscle as a donor nerve to supply electrical input to the facial nerve in order to restore a patient’s smile. Patients usually stay in the hospital for one or two days following this procedure.
Gracilis free muscle transfer for chronic facial paralysis
Background: The gracilis muscle transplant procedure has the ability to restore moving, functional muscle to the face. This is particularly useful in cases of long-standing facial paralysis, also called chronic facial paralysis. The procedure involves harvest of muscle from the inner thigh through a surgical incision. The gracilis muscle is detached, including its blood vessels and nerve. The muscle is then transplanted to the paralyzed side of the face, and connected to a nerve and blood vessel.
Once the gracilis muscle is transplanted to the paralyzed side of the face, it must be connected to a new nerve, so that it may move the paralyzed side of the face. The gracilis muscle may be connected to the nerve to master (which is normally used for biting/chewing), to a cross-facial nerve graft, or to both nerves simultaneously. These options are decided based on a discussion between the surgeon the patient. In general, the gracilis may be performed in a single surgery, or in two surgeries that are separated by approximately 9-12 months. Patients usually stay in the hospital for approximately five days after this surgery.
Static Sling (Facelift and sling to support the corner of the mouth)
The most time-tested treatment for facial paralysis involves a facelift on the paralyzed side of the face, combined with a soft tissue “sling” used to pull up the corner of the mouth. In this procedure, tissue called fascia is harvested from the thigh through a surgical incision. Fascia is a form of connective tissue, which in this location is relatively strong and inelastic. Following a facelift on the paralyzed side of the face, this tissue is then sewn to the corner of the mouth and used to lift it. This provides relatively quick improvement in facial symmetry, speech, and helps keep food in the mouth. Most patients experience initial “over-correction” that relaxes with time. This means that immediately after surgery the corner of the mouth is elevated into a prominent smile that relaxes with time. This surgery is relatively quick, and the benefits of it are realized rapidly after surgery once swelling subsides. The downside is straightforward: no movement is restored to the face.
Temporalis tendon transfer
The temporalis muscle is situated on the side of one’s head, and is one of four major muscles used for chewing. It attaches to the jaw bone (mandible), and helps to close the jaw when chewing. The muscle, and its bony attachment, can be cut through a skin incision that is placed in a natural skin crease between the lip and cheek. The tendon and bone are then sewn to the corner of the mouth in order to attach them together. This results in the corner of the mouth being pulled upwards. In many patients, they may then use the temporalis muscle to produce a smile. In general, the amount of movement with this smile is small and somewhat subtle. However, this procedure provides a very long-lasting suspension of the face, and immediately results in improved speech and eating. There is mild to moderate discomfort in the jaw after this procedure, but not significantly more than the other surgical options listed here. This is also a relatively quick procedure that can last for many years.
Microvascular decompression for Bell’s Palsy
In some cases of severe Bell’s Palsy, a surgical decompression of the facial nerve may be indicated in order to relieve pressure on the facial nerve and increase the likelihood of facial nerve recovery.
Microvascular decompression for Hemi-facial spasm
Dr. Giannotta’s multidisciplinary team has developed neurosurgical techniques to treat hemifacial spasm and trigeminal neuralgia. The neurosurgical team has experienced extremely low complication rates with a high degree of success and has published its results in medical journals.
Clinical trials are scientific studies conducted with volunteers in order to evaluate new treatments. Before a new treatment is tried with human patients, it is carefully studied in the laboratory. Laboratory research points out the new methods most likely to succeed but this early research cannot predict exactly how a new treatment will work with patients. With any new treatment there may be risks as well as possible benefits. There may also be some risks that are not yet known. Currently, we have the following active clinical trials to benefit patients with Bell’s Palsy.
Active clinical trials
Targeted electrical stimulation for treatment of poor prognosis Bell’s Palsy
Current clinical practice guidelines encourage the use of electrodiagnostic testing in patients with severe Bell’s palsy as a means of determining prognosis of recovery and candidacy for possible surgery. In patients who forgo surgery, there is no additional medical treatment offered outside of routine use of oral steroids and antiviral medication. This double-blind, randomized controlled trial seeks to enroll patients with severe Bell’s palsy, who may benefit from targeted electrical pacing of the buccal branch of the facial nerve.
Visit clinicaltrials.keckmedicine.org to view a list of active trials currently available at Keck Medicine of USC.
Basic science research
Using the latest technology in genetics, stem cell medicine, neuroscience and biomedical engineering, researchers find advanced solutions for disorders of the head and neck. Our researchers at the USC Facial Nerve Center are currently studying the role of stem cells in the treatment of peripheral motor nerve injury in facial paralysis. To learn more, visit the USC Caruso Department of Otolaryngology – Head and Neck Surgery at the Keck School of Medicine here: www.keck.usc.edu/otolaryngology/research/basic-science-research
The USC Facial Nerve Center is led by Jon-Paul Pepper, MD, a Facial Plastic and Reconstructive surgeon. He is a fellowship-trained facial nerve expert, and leads a multi-disciplinary team of specialists in providing care for patients with facial nerve dysfunction. He also maintains an active research program dedicated to improving outcomes after facial paralysis and identifying new therapeutics that may likewise improve the lives of patients with facial paralysis.
Practicing LocationsKeck Medicine of USC - Beverly Hills
USC Healthcare Center 4
Acoustic Neuroma, Meningioma and Facial Nerve Tumors, Skull Base Surgery, Microvascular Decompression, Chronic Ear Infections, Otosclerosis, Meniere’s Disease and Pediatric and Adult Cochlear Implants
Practicing LocationsUSC Healthcare Center 2
Cerebrovascular Disease of the Brain and Spinal Cord, Surgical Approaches to the Cranial Base, Stereotactic Radiosurgery, Microvascular Decompression for Bell’s Palsy, Lateral Skull Base Surgery for Facial Nerve Tumors
Practicing LocationsKeck Hospital of USC
Keck Medicine of USC - Downtown Los Angeles
Practicing LocationsUSC Healthcare Center 4
Extended Midface Lift for Facial Paralysis; Botulinum Toxin for Facial Spasm, Synkinesis and Contralateral Hyperkinesis; Brow Lift and Eyelid Surgery for Facial Dysfunction
Practicing LocationsKeck Medicine of USC - Downtown Los Angeles
Keck Medicine of USC - La Cañada Flintridge
USC Healthcare Center 4
Facial Reanimation Surgery; Nerve and Muscle Transfer Surgery; Botulinum Toxin for Synkinesis, Facial Spasm and Contralateral Hyperkinesis; Hyaluronic Acid Filler for Facial Asymmetry and Speech Improvement