CN7 Facial Nerve Damage

Last Updated: 04/14/14

Index

  1. Reasons for Facial Nerve Damage
  2. About the Facial Nerve
  3. Facial Nerve Damage Issues
  4. Common Questions
  5. Healing Time
  6. Things That Can Aid in Healing
    • Facial Nerve Physical Therapy
    • Acupuncture
    • Food, Supplements and Medication
    • Facial Reanimation Surgery
  7. Related Resources
  8. Suggested Reading:
    NF2 Eye and Vision Issues

1. Reasons for Facial Nerve Damage

NF2 results in hearing and balance issues in 90% of people. This is the result of VS (Vestibular Schwannoma), Schwannoma tumors on the Vestibular Nerve, often till the nerves are destroyed.

The Vestibular Nerve is very close to the Facial Nerve and many individuals with VS damage also have Facial Nerve damage they are likely to have some degree of Facial Paralysis.

Damage to the Facial Nerve can happen as a result of:

For individuals with NF2, medical treatments are often necessary because a tumor is life threatening, other treatments are necessary to help individuals maintain a normal life, an example of that would be for the prevention of hearing loss. Since there is currently no treatment to destroy all tumors developed as a result of NF2, medical treatment is only a matter of tumor management.

The facial nerve can easily be broken or otherwise weakened, during treatment management of Vestibular Schwannoma. There are different treatment techniques surgery, radiation and chemotherapy trials for different approaches to manage tumors. Options are often based on; exact tumor location, tumor size, a tumors shape and rate of growth, in addition to; an individual's age, height, weight and general health. Some of the different treatment options can ultimately lead to damage to the facial nerve.

2. About the Facial Nerve

Inside the Skull

CN7 and CN8

Vestibular Shwanoma, Shwanoma tumors along Cranial Nerve 8, are an issue that develops in many individuals with NF2.

Cranial Nerve 8 travels a similar path as Cranial Nerve 7 (the Facial Nerve), extending out of the brainstem right next to each other. The purpose of CN8 is hearing and balance.

Learn more about Hearing and Balance: CN8 - Vestibulocochlear Nerve.


Major Nerve Branches Outside of the Skull
Facial Nerve

The facial nerve branches off to smaller nerves and muscles that go to 5 different parts of the face. Therefore, when the nerve is damaged those smaller veins are not supplied with enough blood for circulation which is necessary for muscles on the different areas of the face to move. Each nerve branch affects the movement of different muscles.

The image to the right and the description shows how far the Facial Nerve reaches.

  1. Temporal Branch
  2. Zygomatic Branch
  3. Buccal Branch
  4. Marginal Mandibular Branch
  5. Cervical Branch

  • 1. Temporal Branch - (Frontal Branch): This Nerve Branch affects the muscles in the Forehead.
  • 2. Zygomatic Branch - (Malar Branches): This Nerve Branch affects the Upper Cheek.
  • 1&2. Temporal & Zygomatic Branch: Together these Nerve Branches affect the muscles control opening and closure of the Eye.
  • 3. Buccal Branch - (Infraorbital Branches): This Nerve Branch affects the Cheek and Above the Mouth Muscles.
  • 4. Marginal Mandibular Branch: This Nerve Branch affects the Chin Muscles.
  • 5. Cervical Branch: This Nerve Branch some of the Neck Muscles.

The nerves in the picture on the right show where on the face, outside of the skull, that the nerve branch extends out. The X in the image is pointing is the approximate location where the nerve extends outside of the skull, before branching to the different parts of the face.

3. Facial Nerve Damage Issues

  • Eyes: The nerves from the Zygomatic Branch results in eyelid problems. This nerve controls the ability or lack thereof to blink or produce tears. Normally blinking coats the eye with a tear each time, without the ability to do so different eye creams and eye protection is needed, or the cornea will crack and permanently damage vision in the eye. Learn about Facial Nerve Damage and Dry Eyes..
  • Eating: Without the ability to move the Buccal branch and the Marginal Mandibular Branch, holding food in your mouth becomes very frustrating, and awkward. Drinking with a straw is often necessary.
  • Talking: The same nerves that make eating difficult can also make properly or clearly pronouncing certain letters hard to do. Letters like - B, P, M and W.
  • Droopy Face: Lack of complete eyelid closure and a fallen smile.
  • Nasal Issues

4. Common Questions

Question 1: Why is the Facial Nerve Damaged during VS (Vestibular Schwannoma) surgery?

Tumors that grow on the nerves that effect hearing and balance tend to push on the Facial Nerve which follows a similar path inside the brain. During different tumor management techniques used to preserve hearing and balance the Facial Nerve is lost.

Question 2: How can Facial Nerve damage be prevented?

Focused radiation treatments typically damage other nerves in the surrounding area, but different Microsurgery surgery techniques to remove VS are less likely to damage the Facial Nerve. However, if the tumor is already affecting the Facial Nerve, the chances of saving the nerve regardless of treatment choice is minimal.

Question 3: In addition to Dry Eyes, what eye issues does Facial Nerve damage result in?

Diplopia (Double Vision or Lazy Eye). Learn about NF2 Eye Issues.

Question 4: Why are other face controls not mentioned here?

The Facial nerve does not control all of the functions of the face and are controlled by Cranial Nerve 5, the Trigeminal Nerve which includes the following 3 branches:

  • Ophthalmic Nerve (V1): Muscles for the eyelids, eyebrow, forehead and nose.
    This branch affects the glands for tear production and mucous membrane of the nasal cavity.
  • Maxillary Nerve (V2): Sensation from the maxillary, nasal cavity, sinuses and taste.
  • Mandibular Nerve (V3): Face Sensations and Muscles for biting, chewing, and swallowing.

Question 5: Is pain a side effect of Facial Nerve Damage?

No. Pain or any other feeling, numbness or lack of feeling in the face is the result of damage of CN5, the Trigeminal Nerve.


5. Healing Time

Nerves that are a part of the Central Nerve System (CNS) do not heal as easily as nerves in other areas of the body. There are things that can be done to help the nerve heal that should be considered when a nerve might or has been damaged.

Natural healing that might take place will not visually be seen till about 4 to 6 months after the damage occurs. Everyone is different, so it might take more or less time for different people, but the majority of the healing that will occur on its own will be in the first year. The nerve damage will unlikely be completely restored on its own but there are some options to consider to help maximize the amount of healing.

6. Things that Can Aid in Healing

A few things can help encourage the most amount of healing:

  • Facial Nerve Physical Therapy
  • Acupuncture
  • Food & Herbs or Supplements
  • Facial Reanimation Surgery

Non-surgical options when possible should be considered before surgical options, but if after time passes those do not do enough for you Facial Reanimation is an option you may want to consider.

7. Facial Nerve Physical Therapy

Facial nerve physical therapy can consist of different types of treatments which should be discussed with a physical therapist.

3 forms of possibly physical therapy include:

  • Muscle Exercise Training - It is suggested to visit a physical therapist as soon as possible after the nerve is damaged for the best and most amount of results, including the prevention of Synkinesis (Movement that results in an involuntary contraction of other facial muscles. Example - the eye muscles causing the eye to squint when smiling)
  • Massage Therapy
  • Electrotherapy - There are different forms of electrical stimulation and it is usually not considered until well after neuropathy has set in. The stimulation jolts all the facial nerves at the same time and can make it harder to control different parts of the face individually, which is required for natural facial expressions Methods on this might include; Electrical Stimulation (ES), Electromyography Biofeedback (EMG Bio), Ultrasound, Laser, or Short-Wave Diathermy (SWD)

8. Acupuncture

Acupuncture helps to stimulate blood to flow back to the different nerves in the face to encourage movement. For maximum results, starting it within a few months after a nerve is damaged is ideal; each weekly treatment will help encourage the blood flow back into the face to help regain control little by little.

Acupuncture Warnings!

  • It is important to get Acupuncture from someone who is a doctor.
  • Many offices that do Acupuncture also do Back Massage to ease back pain and is very dangerous for individuals with spine tumors and should not be done to any of us with NF2.
  • It is very important to go to a medical professional, a certified doctor, for acupuncture. Needles placed in the wrong location can cause serious harm or even kill the patient being treated. - Read More

9. Food and Supplements

Antioxidants help encourage blood flow by helping to send more oxygen to veins; as a result they increase the circulation through the entire body.

A few glasses of water will also help with overall circulation. If you drink anything that dehydrates you like coffee or alcohol, you need to drink more than the standard amount of water for your body size.

Remember, all things should be taken in moderation.

Cayenne Pepper, Ginkgo Biloba, Garlic and Hawthorn Berry.


10. Surgical Options

I. Nerve Grafting

  • During VS Removal and Initial Facial Nerve Damage:
  • Vestibular Schwannoma (VS) surgery can result in damage to the facial nerve, but different techniques during surgery would make this less likely. Technique to remove these tumors and should be discussed with the surgeon.

    If the nerve is damaged during surgical intervention to remove a Vestibular Schwannoma, the Facial Nerve, CN7, it might be possible to reattach the nerve to the Hypoglossal Nerve, CN12. This type of nerve graft can be done to try to regain blood flow to the nerve immediately after the nerve loses connectivity.

    During surgery if the nerve is only damaged or some attempt to simply reconnect the nerve is done, some amount of healing will take place naturally with help from just physical therapy and time. It would be up to the patient to decide when or if additional surgical methods might be desired.

  • Nerve Reconnection Surgery:

II. Free Muscle Transplant

A Free Muscle Transplant is when a healthy "extra" muscle and transplanting it somewhere else in the body. The muscle can be used anywhere but needs to be attached somewhere with a working nerve.

Years after the facial nerve is damaged, you may want to consider Facial Reanimation surgery depending on how much has of the nerve has recovered or not. In this procedure the area the surgery happened is reopened from the ear down to the chin under the jaw bone. The nerve is reconnected to raise the droop in the face. There are different methods for this, talk to your doctors.

  • Pedicled Masseter Muscle Transfer (PMMT): Transfer of the working muscle from one side of the face to the other.
  • Free Gracilis Muscle Transfer: Transfer of the legs muscle to the face followed by nerve relocation from the leg to the face several months later.
  • Free Abductor Hallucis Muscle Transfer: Relocation of a muscle in the foot.

III. NF2 Smile Project

'Help Stop NF2 - NF2 Smile Project', is an organization whose goal is to help cover expenses so more people can have the different Facial Reanimation surgeries after NF2 - Facial Nerve Damage.

IV. NF2 Eye and Vision Issues: Dry Eyes and Excessive Tearing



11. Definitions

  1. Gracilis Muscle: A muscle of the thigh portion of the leg.
  2. Abductor Hallucis Muscle: A muscle in the foot.

12. Reference Sources

  1. Vakharia, Kalpesh T., et al. "Facial Reanimation of Patients With Neurofibromatosis Type 2." Neurosurgery 70 (2012): ons237-ons243. http://www.triomeetingposters.org/wp-content/uploads/2010/04/A113.pdf


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