About 90% - 98% of people with NF2 develop VS (Vestibular Schwannoma), but NF2 is not the only reason VS might grow. VS (Vestibular Schwannoma) are Schwannoma tumors on the Vestibular Nerve grow and destroyed the nerve. As thest tumors grow larger they also damage other nerves.
The Vestibular Nerve is very close to the Facial Nerve and many individuals with Vestibular Schwannoma damage also have Facial Nerve damage which results in some degree 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.
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.
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.
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.
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.
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.
Diplopia (Double Vision or Lazy Eye). Learn about NF2 Eye Issues.
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:
No. Pain or any other feeling, numbness or lack of feeling in the face is the result of damage of CN5, the Trigeminal Nerve.
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.
A few things can help encourage the most amount of healing:
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.
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:
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.
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.
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.
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.