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CN7 Facial Nerve Damage

Facial Palsy

Last Updated: 10/24/17


  1. Reasons for Facial Nerve Damage
  2. Facial Nerve Information
    1. Temporal Branch
    2. Zygomatic Branch
    3. Buccal Branch
    4. Marginal Mandibular Branch
    5. Cervical Branch
  3. Facial Nerve Damage Issues
  4. Natural Healing Time
  5. Things That Can Aid in Natural Healing
    • Facial Nerve Physical Therapy
    • Acupuncture
    • Food, Supplements and Medication
  6. Medical Treatment
  7. Common Questions
  8. Definitions
  9. Reference Sources

1. Reasons for Facial Nerve Damage

Damage to the Cranial Nerve 7 - Facial Nerve can happen as a result of:

i. Vestibular Schwannoma

About 90% to 98% of people with the health condition of Neurofibromatosis Type 2 (NF2), develop Vestibular Schwannoma (VS) on the Cranial Nerves for both sides of their head. These VS are sometimes also referred to as Acoustic Neuroma (AN). NF2 is not the only reason VS might grow.

When Schwannoma type tumors grow on the Vestibular Nerve, which affects balance, they are referred to as Vestibular Schwannoma. However, as these tumors grow they often damage surrounding nerves starting with the Cochlear Nerve and eventually the Facial Nerve but damage to potentially even more important nerves that could be fatal can be damaged if no treatment for the tumor is received. Treatment would be needed before those nerves are compromised.

ii. Face Tumor or Other Trauma

If a tumor grows on some part of the face, or trauma to the face occurs, Facial Nerve function can be an issue, but depending on how far away from the point the nerve leaves the skull will determine what functions might be lost.

If damage to the face itself causes severe pain or numbness, damage to Cranial Nerve 5, the Trigeminal Nerve may also be an issue. Chances of natural healing or surgical reanimation offer a good chance of healing all or a higher percentage of the damage then when damage is done to the Facial Nerve when damaged inside the brain.

iii. Face Tumor or Other Trauma

There are different treatment techniques for brain tumor removal; currently at least three for Vestibular Schwannoma removal with surgery, and different methods for of radiation treatments, but sometimes Facial Nerve damage, Facial Palsy, still occurs.

When a highly trained surgeon is found and allowed to help, the sooner treatment is given and the smaller a tumor or damage is, the better chances are of nerve preservation can take place.

2. Facial Nerve Information

Inside the Skull

CN7 and CN8, Facial Nerve,

Vestibular Schwannoma, are Schwannoma 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. Individuals who develop Vestibular Schwannoma commonly develop damage to the Facial Nerve; also known as Facial Nerve damage, or Facial Paralysis.

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

Facial Nerve Damage
  • Eyes: The nerves from the Zygomatic Branch results in eyelid problems.
    This nerve controls the ability or lack thereof to either; 1) Blinking, or 2) Tear Produce, but it can also cause 3) Ptosis (Droopy Eyelid). Some of these things eyelid issues can be used as early indicators an individual is facing Facial Nerve damage. 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: Constant runny nose or Congestion
  • mouth, glands, Salivary Glands, parotid gland, submandibular gland, sublingual gland
  • Saliva and Tooth Decay / Dry Mouth: Anything that diminishes the flow of saliva will dramatically increase the incidence of tooth decay.
    Although medications that stimulate Salivary Glands secretion are available, their side effects (nausea and diarrhea) often make them poorly tolerated. There are a variety of "artificial saliva" products that are available for purchase over the counter. But there is no substitute for prescription-strength topical fluoride preparations, whether; 1) applied in the dental office with fluoride varnishes, or 2) as prescription fluoride products for home use. No other products come close in terms of their effectiveness at preventing tooth decay, or are as well supported by clinical evidence.
  • Lack of Cpmtrol of Wrinkled Forehead Symmetry

4. Natural 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 until 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.

5. Things that Can Aid in Natural Healing

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

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

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.

I. Food and Supplements

  • Antioxidants: Antioxidants are found in a large list of foods and help encourage blood flow by helping to send more oxygen to veins; as a result Antioxidants increase the circulation through the entire body.
  • Water: 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.
  • Food or Supplement Options: Cayenne Pepper, Ginkgo Biloba, Garlic and Hawthorn Berry.
  • Vitamin B12: Vitamin B12 is important in the formation of all cells in the body, especially red blood cells and the covering of nerve cells (myelin). The body needs myelin for nerves to heal and function properly. B121 also helps with the immune system.

Remember, all things should be taken in moderation.

II. 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)

III. 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.

6. Medical Treatment 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 Eye and Vision Issues

While there are Nerve and Muscle grafts and transplant options for moving most of the face, simple treatments are available for some of the Dry Eyes and Excessive Tearing issues that are caused by Facial Nerve Damage.

iv. Forehead Wrinkling - BOTOX® (Botulinum toxin)

BOTOX® (OnabotulinumtoxinA) also known as Botulinum Toxin Type A is a Botulinum toxin produced by Clostridium Botulinum Bacteria.

Issue: Wrinkled Forehead Only on the side of No Paralysis

Facial Paralysis results in an inability to show expression on the side of the face an individual has Facial Paralysis. While looking for options for movement on the side with the facial paralysis, individuals may also be looking for limitations of movement on the other side, to prevent Forehead Wrinkling. BOTOX for paralysis patients is something insurance will cover and is something to consider, but it is also important to know risks. If the side effects listed develop, first response may need to be to discontinue the treatment before considering other health issues as the cause. Talk to your doctor.

"When a small amount of Botox is injected into a muscle, it blocks nerve signals that tell your muscles to contract. The effect is that it temporarily weakens or paralyzes the facial muscles and smooths or eliminates wrinkles in the skin for a few months." [WebMD, BOTOX]

"Very serious problems can happen if the botulinum toxin spreads from where it was injected. It may cause dangerous issues like; swallowing or breathing problems. These problems can happen hours to weeks after the injection and can cause death. The risk is greatest in children who are being treated for muscle spasticity in their necks. But adults who already have swallowing or breathing problems are also at risk for problems from a Botox injection." [WebMD, BOTOX]

"The risks of repeated Botox injections are not known." [WebMD, BOTOX]

Other reasons for possible swallowing issue include tumor growth on the; lower branch of Trigeminal Nerve (Cranial Nerve 5 the Mandibular branch), or 2) Vagus Nerve (Cranial Nerve 10). A tumor on the Vagus Nerve could also result in breathing issues.

There is a one-percent (1%) risk of illness from Botulinum infection for people taking CAPE Propolis.

7. Common Questions

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

Tumors that grow on the nerves that affect 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: In treatment of Vestibular Schwannoma (VS), what can be done to prevent Facial Palsy?

Focused Radiation treatments can damage 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 chance of saving the nerve regardless of treatment choice would be minimal.

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

Facial Nerve damage can also cause Diplopia (Double Vision or Lazy Eye), as well as Nystagmus and Oscillopsia. 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 Cranial Nerve 5 (CN5), the Trigeminal Nerve.

8. Definitions

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

9. 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
  2. "House-Brackmann Classification of Facial Function" MedScape (Updated: Dec 08, 2014) http://emedicine.medscape.com/article/2172449-overview
  3. WebMD. "Botulinum Toxin BOTOX" http://www.webmd.com/beauty/botulinum-toxin-botox
  4. MedlinePlus. "BOTOX" https://medlineplus.gov/botox.html
  5. NF2 Information and Services. "CAPE Propolis" https://www.nf2is.org/bio30.php