The School of Medicine launched the Facial Nerve Center this spring, bringing together a team of 18 practitioners to treat patients of all ages affected by facial paralysis. In a media briefing May 14, Sam Oyer, co-director of the Center and otolaryngologist, explained that the Center is not a physical location but rather is a way of formalizing the care already within U.Va. Health.
“The Center is … formalizing the multidisciplinary treatment that we already have,” Oyer said in the media briefing. “We have all these different people who collectively take care of parts of the face, and we've basically collated that into … the Facial Nerve Center … It's this combination of like-minded people who treat different parts of the face — so it's really multidisciplinary care that can come under one roof of U.Va. Health.”
Oyer said the Center’s purpose is to provide more centralized access to the spectrum of care needed for facial paralysis patients, with neurosurgeons, otolaryngologists, neurotologists, ophthalmologists, emergency medicine doctors, physical therapists and mental health providers, and to be a regional center for patients from anywhere to receive treatment.
Facial paralysis — affecting approximately 225,000 people per year in the U.S. — is a condition resulting in the loss of function on one or both sides of the face due to seventh cranial nerve damage, which is the facial nerve.
“The symptoms are very apparent, so it's not something that hides … easily,” Oyer said in the media briefing. “Usually, it's weakness of any part of the face. Most commonly, people say they wake up in the morning, they go to brush their teeth, or they go to drink their coffee, and it trickles out of their mouth … So, basically, it's … lack of motion of any portion of the face.”
In the U.S., there are only about 30 to 40 facial nerve centers and facial paralysis institutes. In an interview with The Cavalier Daily, Oyer explained that the Center at the School of Medicine provides a place for doctors and institutions from around the area to send patients who require a high level of care across multiple specialties.
“The goal was to promote the care that we have to other providers within the community, or even within the larger state of Virginia and beyond, just to let people know that it’s kind of a nuanced treatment and not everybody knows what’s available,” Oyer said in the interview. “[It’s] really a way to help spread the word for patients and referring doctors and providers, [to let them] know that we can offer the full spectrum of care here.”
Bell’s palsy is the leading cause of facial paralysis in both children and adults, Oyer said. Typically a temporary paralysis of the face, Bell’s palsy has a sudden onset over one to two days, according to Oyer, in which one side of the face loses movement. The Mayo Clinic explained it can be caused by a viral infection such as infectious mononucleosis or the herpes virus. In approximately 70 percent of patients, according to Oyer, Bell’s palsy can heal completely on its own or with steroids and antiviral treatments. The other 30 percent of patients will not recover fully and may require more extensive treatment, like facial reanimation surgery.
Oyer said tumors such as skull-based tumors, parotid gland tumors or vestibular schwannomas — also known as acoustic neuromas — are the second leading cause of facial paralysis. Vestibular schwannomas are benign brain tumors that grow on the eighth cranial nerve, immediately next to the facial nerve in the brain.
Oyer explained that a neurotologist — a specialized ear, nose and throat doctor focusing on neurological disorders of the inner ear, skull base and nerves — and a neurosurgeon can work together to remove a vestibular schwannoma from a patient, and an otolaryngologist — an ear, nose and throat doctor — can operate either before or after the brain tumor resection to repair the facial nerve, if needed.
Other prominent causes of facial paralysis include trauma to the facial nerve via car accidents, falls or skull fracture trauma. In children, Moebius syndrome is a rare congenital condition in which children are born with underdeveloped sixth and seventh cranial nerves, resulting in facial paralysis and the inability to move their eyes side to side.
No matter the cause, Oyer explained the multidisciplinary care needed to treat facial paralysis. Each practitioner of the team is essential, Oyer said, from the emergency medicine doctors who see patients when they first come into the hospital with facial weakness to the mental health providers who assist patients dealing with anxiety and depression.
“As you can imagine, a person who has trouble with their face can have trouble with their eyes, they can have trouble with their speech, they can have all sorts of difficulty, even including their psyche,” Oyer said in the media briefing. “[There are] a lot of issues that come up with mental health. Anxiety [and] depression are much, much more common when we can't move our face well.”
Looking forward, Oyer noted goals to relocate some practitioners’ offices within the Center to be physically closer to one another. He explained the twofold benefits that could come from practitioners in the Center having shared or closer offices. The first is that patients could see all caretakers they need in one visit — like an otolaryngologist, physical therapist and mental health provider — and the second is that communication between practitioners could become more efficient.
Oyer also noted the example of a fellowship at U.Va. Health sponsored by the American Academy of Facial Plastic and Reconstructive Surgery, to which residents can apply. Residents who have completed all five years of surgical residency in Otolaryngology-Head and Neck Surgery or Plastic Surgery are eligible to apply for the one-year fellowship to receive specialized training in areas such as facial reconstruction, hair transplantation and more.
Oyer said that this fellowship at U.Va. Health is another way to expand care for facial paralysis patients, and “focuses on facial paralysis treatment and facial reconstruction along with aesthetic facial surgery and facial rejuvenation.” He emphasized that fellows who are trained and become specialized in facial paralysis treatment during their time at the School of Medicine can go on to bring care to other parts of the country when their training is complete.
“We hope that in years to come, there's not a small number of facial nerve centers … so that people don't have to travel a long way to get this care,” Oyer said in the interview. “In the meantime, we hope to be in one of those regional centers where people can come from all over and get specialized care if they don't have somebody locally who can do it.”
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