Restorative Facial Surgery for a Patient with Facial Nerve Paralysis

After treatment for parotid gland cancer, 75-year-old patient Gilbert Engelmann, from France, experienced complications, resulting in facial nerve paralysis. This condition left half of his face immobile, sagging, with his eye unable to fully close, leading to dryness and discomfort. FV Hospital doctors performed a surgery to transfer the temporalis muscle flap to restore Mr Engelmann’s paralysed facial muscles and rejuvenate his face.

Mr Engelmann before and after surgery. 

Facial deformation due to facial nerve paralysis

In 2018, Mr Engelmann had a malignant tumour in the parotid gland, a salivary gland that sits just in front of the ears, on the left side of his face. After surgery to remove the tumour, he experienced a complication known as facial nerve paralysis, which left the left side of his face partially paralysed and drooping significantly. This had a profound impact on his ability to communicate and eat. The sagging facial muscles also prevented him from fully closing his left eye, leading to complications such as dry eyes and constant tearing.

Patient Gilbert Engelmann’s face before surgery. 

In August 2023, Mr Engelmann came to FV Hospital with the hope of improving his facial paralysis issue. Nguyen Thanh Tung, MD, PhD, Head of the Oral & Maxillofacial Surgery-Dental Surgery Department at FV Hospital, stated: “Normally, surgeries to remove tumours located near the facial nerves pose a high risk of damaging the nerves during surgery. In the case of parotid gland cancer, the malignant tumour is highly invasive and the facial nerves are very vulnerable to injury, leading to facial paralysis after surgery.”

Nguyen Thanh Tung, MD, PhD, Head of the Oral & Maxillofacial Surgery-Dental Surgery Department examines Mr Engelmann.

The surgery involved transplanting the temporalis muscle flap to reconstruct paralysed facial muscles.

Identifying this as a complex case, doctors at FV Hospital convened a consultation to determine the best course of action. Lam Hoai Phuong, MD, PhD, a Senior Doctor in the Department of Oral & Maxillofacial Surgery-Dental Surgery at FV Hospital and a leading expert in facial reconstructive surgery in Vietnam with over 41 years of experience, assessed that the treatment for this patient required temporalis muscle flap surgery.

“This patient’s condition, if left untreated, would lead to persistent redness and tearing of the eye due to the patient’s inability to close it. Consequently, the patient’s eyes would gradually become dry, leading to a loss of vision,” says Dr Hoai Phuong.

This was a complex surgical procedure that demanded the skill, precision, and accuracy of FV’s experienced medical team, and the active support of advanced medical equipment and techniques. Doctors carefully evaluated potential risks that could arise during the surgery due to the patient’s advanced age, previous surgical history, and medical conditions, such as a history of cerebrovascular events in 2002 and the insertion of three stents, which necessitated anticoagulant medication. These factors increased the risk of bleeding during the surgery.

On August 24, 2023, Dr Hoai Phuong and the surgical team operated meticulously for over six hours, closely monitoring physiological indicators throughout the procedure to prevent bleeding. The patient’s temporalis muscle was transplanted downward, the lower eyelid was elevated, and the entire temporalis muscle portion was connected to the lower eyelid to reduce the risk of exposure.

FV’s nursing staff care for Mr Engelmann following his surgery. 

After the surgery, Mr Engelmann showed significant improvement in his facial appearance. After one week, he received guidance from experts on physical therapy to stimulate the facial muscles. His face became more natural and harmonious, his eyes closed relatively well, and he no longer experienced excessive tearing, drooling, or food spilling out of his mouth.

Lam Hoai Phuong, MD, PhD, examines Mr Gilbert Engelmann. 

Doctors advised Mr Engelmann to continue with physical therapy exercises to get accustomed to moving his facial muscles. When looking at his face in the mirror, Mr Engelmann expressed his happiness with the results after the surgery. He said, “I am very satisfied with the surgery. If I compare my appearance before and now, I can see a significant improvement!” He also appreciated the talent and dedication of FV’s doctors who worked tirelessly to restore his smile. Additionally, FV Hospital supported him in working with his insurance company to cover a significant portion of the surgery costs, easing his financial burden.

To learn more about the Oral & Maxillofacial Surgery-Dental Surgery Department, FV Hospital, please call (028) 54 11 33 33.

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