When the smile returns: reconstructive surgery for facial paralysis

Two stories, two trajectories

The fates of Sylvianne Hermann and Beat Wehrli illustrate the different courses of facial paralysis.

Sylvianne Hermann was 69 years old when a tumor on her salivary gland had to be removed. "My biggest fear was walking around the world with a different face," she says. As the tumor had attacked the facial nerve, parts of it had to be removed as well.

Beat Wehrli was a different story: at the age of 86, he was already suffering from severe facial paralysis caused by a tumor that was removed too late. "People started to stare at me. I withdrew more and more," he reports.

Treatment at the University Hospital Basel

Both patients were referred to the University Hospital Basel, where ENT specialist Laurent Muller and plastic surgeon Tarek Ismail work closely together.
"Mrs. Hermann not only wanted to survive, but also to regain her quality of life," explains PD Dr. Ismail. With a nerve transplant from the lower leg and a tissue transplant, it was possible to reconstruct the facial nerve and restore symmetry.

Mr. Wehrli's situation was more complex. "The paralysis had been present for a year and a half," says PD Dr. Muller. "We had to restore contour and volume and also reconstruct statically by tightening the midface. We also transplanted a muscle and connected it to the facial nerve."

Early action is crucial

The doctors emphasize the importance of a quick diagnosis. "Mrs. Hermann's muscles were still intact, so the result was very good," says PD Dr. Ismail. "In Mr. Wehrli's case, the muscles had to be replaced, which only works to a limited extent in old age."

At the University Hospital Basel, the healing process is being documented as part of a study using artificial intelligence, which analyzes the quality of facial expressions, among other things. Both patients have significantly improved their quality of life as a result of the operation. "It's a huge difference, of course," says Wehrli. Ms. Hermann adds: "I had really good doctors and good luck."

Causes of facial paralysis

In the studio interview, PD Dr. Ismail explains that tumors are not the only cause of facial paralysis. More common is so-called idiopathic facial paralysis, the cause of which is unknown. "Two thirds of all cases remain unexplained," says Ismail. "It is crucial to clarify the cause within six months. The muscles die after eight to nine months." Nerve reconstructions are particularly reliable in younger patients. However, the success rate decreases with increasing age.

Methods of reconstructive surgery

Different reconstructive procedures are available depending on the cause and severity of the facial paralysis. In dynamic reconstruction, for example, nerve or muscle transplants are used to restore facial mobility and facial expressions as completely as possible. Static reconstruction focuses on improving contour and symmetry, for example through tightening or implants. Both approaches can be combined individually to correct function and appearance in the best possible way and significantly improve the patient's quality of life.

Find out more in the "gesundheit heute" TV report.