Traumatic and Surgical Facial Nerve Injury
Expert microsurgical repair and facial reanimation when the unexpected happens.
How Do Facial Nerve Injuries Occur?
The facial nerve (the 7th cranial nerve) exits the skull just below the ear and branches out across the face like the fingers of a hand. Because these branches lie very close to the surface of the skin, especially in the cheeks, jawline, and near the ears, they are vulnerable to injury. We classify these injuries into two main categories:
Iatrogenic (Surgical) Injuries
Even in the hands of skilled surgeons, the facial nerve can be stretched, bruised, or accidentally severed during complex operations in the head and neck. Common procedures that carry this risk include:
- Parotid Gland Surgery: Removing tumors from the salivary gland, which the facial nerve runs directly through.
- Cosmetic Surgery: Deep plane facelifts or neck lifts.
- Mastoid and Ear Surgery: Procedures addressing chronic ear infections or tumors.
- Temporomandibular Joint (TMJ) or Jaw Surgery.
Traumatic Injuries
These are the result of sudden accidents.
- Blunt Force Trauma: Temporal bone fractures (skull fractures) from falls or vehicle accidents that crush the nerve inside its bony canal.
- Penetrating Trauma: Deep facial lacerations from glass, sharp objects, or animal bites that sever the nerve branches directly.
The Window for Repair: Why Time is Critical
If you have suffered a sharp injury (such as a deep laceration or a known surgical cut to the nerve), immediate intervention is crucial. When a nerve is severed, the ideal time to reconnect it is within the first 72 hours. During this window, the nerve endings can still be stimulated electrically, allowing the surgeon to accurately identify and reconnect the precise branches before they degenerate.
If your injury is older, hope is not lost. The facial muscles remain receptive to new nerve signals for roughly 12 to 24 months. After this window, the muscles begin to permanently atrophy, requiring different, more complex reconstructive approaches. Do not wait to seek a specialized evaluation.
Recognizing the Symptoms of Nerve Damage
The symptoms of a facial nerve injury depend entirely on which specific branch of the nerve was damaged, and whether the nerve was bruised (which may heal) or completely severed.
Immediate Flaccid Paralysis
Occurring right after the trauma or surgery, the affected side of the face loses muscle tone. You may experience a drooping eyebrow, a flattened cheek, and difficulty keeping liquids in your mouth while drinking.
Eye Closure Deficits (Lagophthalmos)
If the branch controlling your eyelid is injured, you will lose the ability to blink or fully close your eye. This leaves the cornea exposed, leading to severe pain, chronic dry eye, and a high risk of permanent vision damage.
Synkinesis (Miswiring)
If the nerve was crushed but not cut, it will try to heal over several months. Sometimes, the nerve fibers grow back to the wrong muscles. This causes "synkinesis": unwanted, simultaneous muscle movements, such as your eye squeezing shut when you try to smile, accompanied by facial tightness and pain.
Advanced Surgical Solutions for Nerve Injury
Treatment is highly individualized. Based on extensive clinical research and advanced microsurgical techniques, Dr. Jowett offers a spectrum of reconstructive options tailored to the exact timeline and nature of your injury.
For recent, sharp injuries (like a facial laceration), the best outcome is achieved by finding the cut ends of the facial nerve and sewing them back together under a high-powered microscope. This provides the most natural chance for recovery.
Frequently Asked Questions
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation. With dual fellowship training in Germany and at Harvard Medical School, he brings a unique engineering and microsurgical background to treating complex facial nerve disorders.
Whether you are days into a diagnosis or have lived with incomplete recovery for years, Dr. Jowett offers the full spectrum of care, from medical management to cutting-edge surgical reconstruction, to help you regain your smile and confidence.
Selected References
- The Tinel Sign and Myelinated Axons in the Cross-Face Nerve Graft: Predictors of Smile Reanimation Outcome for Free Gracilis Muscle Transfer? Dusseldorp JR, et al. Plast Reconstr Surg. 2022 Jun 01; 149(6):1393-1402. doi: 10.1097/PRS.0000000000009167. PMID: 35613288.
- A Rapid Protocol for Intraoperative Assessment of Peripheral Nerve Myelinated Axon Count and Its Application to Cross-Facial Nerve Grafting. Wang W, et al. Plast Reconstr Surg. 2019 Mar; 143(3):771-778. doi: 10.1097/PRS.0000000000005338. PMID: 30601328.
- A General Approach to Facial Palsy. Jowett N. Otolaryngol Clin North Am. 2018 Dec;51(6):1019-1031. doi: 10.1016/j.otc.2018.07.002. PMID: 30119926.
- A Contemporary Approach to Facial Reanimation. Jowett N, Hadlock TA. JAMA Facial Plast Surg. 2015 Jul-Aug;17(4):293-300. doi: 10.1001/jamafacial.2015.0399. PMID: 26042960.