Disorders of the facial nerve are extremely complex and can significantly affect quality of life. William Townley is a lead clinician in the Facial Nerve Centre at Guy’s and St. Thomas’. He runs a multidisciplinary team with specialists in ENT, Paediatric Plastic Surgery, Ophthalmology and Facial Physiotherapy. In addition, he is a member of the Sir Charles Bell Society, an international organisation of experts from different specialties dedicated to improving outcomes in facial palsy.
William has visited and trained in several international units (London, Toronto, Boston, Vancouver) to learn contemporary techniques and facilitate an innovative approach to his own practice. The facial nerve powers the muscles that are responsible for essential emotional expressions such as smiling as well as basic functions including, eating, speech and eye closure. Facial nerve injuries can therefore be devastating, both from a functional and aesthetic viewpoint. William offers the full spectrum of facial reanimation treatments to children and adults suffering with facial paralysis from simple chemodenervation techniques (botulinum toxin for synkinesis) to free functional muscle transfer.
There are many causes of facial nerve injury and patients need to be assessed on an individual basis to determine likely prognosis and best course of action. A list of common procedures performed by William is listed below. Most procedures require diligent physiotherapy to get the best results.
Dynamic procedures – interventions that can restore movement to the affected side of the face by powering the normal facial muscles or by harvesting the power of other muscles to do a similar job
Free Muscle Transfer (Gracilis)
The gold standard reconstruction in patients with a long-standing facial paralysis. When powered by a nerve graft connected to the other (‘intact’) side of the face, it gives the best chance of a spontaneous and symmetric smile.
Temporalis Sliding Myoplasty
An increasingly popular technique for restoring the ability to smile. Requires intense physiotherapy afterwards to ‘learn’ to smile again. May be suitable for elderly patients with long-standing facial paralysis looking for a simpler operation.
Nerve Transfer or Graft
May be appropriate in patients who have had a recent onset of facial paralysis. Often performed in conjunction with other procedures such as tumour removal.
Static procedures – a series of interventions that can improve position of the affected side of the face as well as function (eye protection, oral control of solids and fluids)
Facial nerve injuries may result in a droopy eyebrow appearance. A browlift is a relatively simple procedure that can elevate the position of the brow to match the unaffected side.
Eyelid Protection (Oculoplastic Surgery)
Simple procedures that can often be done as an outpatient under local anaesthetic to facilitate eye closure and eyelid position. These include:
• Goldweight to the upper eyelid
• Lower eyelid tightening (lateral tarsal strip)
• Eyelid bag removal (blepharoplasty)
Static Sling to Cheek
A simple procedure that can improve the position of the face at rest by using a piece of fibrous sheet to tighten and lift the cheek.
A face-lift can be used in conjunction with other techniques to improve facial symmetry at rest.
Botulinum Toxin (Chemodenervation)
Botox may be injected into the affected side of the face to relax any facial muscles that have become tight, or to reduce unwanted muscle movements. It can also be used on the unaffected side of the face tom improve the overall symmetry and appearance.
Come for a consultation to discuss corrective surgery for facial palsy in detail.
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