Facial Paralysis After Acoustic Neuroma
(Vestibular Schwannoma)
Reclaiming Your Smile and Your Confidence After Tumor Surgery
What is an Acoustic Neuroma?
An acoustic neuroma (also known as a vestibular schwannoma) is a rare, benign (non-cancerous) tumor that develops on the 8th cranial nerve leading from your inner ear to your brain. This nerve complex is responsible for both your hearing and your balance.
While the tumor itself does not originate on the facial nerve (the 7th cranial nerve), the two nerves run intimately close together through a very narrow bony canal. As an acoustic neuroma grows, or during the delicate neurosurgical process required to remove it, the adjacent facial nerve can become stretched, compressed, or injured, leading to partial or complete facial paralysis.
Information supported by the American Brain Tumor Association.
The Story of Your Nerve: Why Did This Happen?
To understand your symptoms and how we can fix them, it helps to understand the anatomy of what happened during your tumor removal.
Deep inside your skull, there is a tiny, bony tunnel called the internal auditory canal. Two very important "cables" run through this narrow space side-by-side:
- The 8th Cranial Nerve: Controls your hearing and balance.
- The 7th Cranial Nerve (The Facial Nerve): Controls your ability to blink, raise your eyebrows, and smile.
An Acoustic Neuroma is a benign, slow-growing tumor that develops on the balance nerve. As it grows, it runs out of room in the canal and begins to violently compress and flatten the adjacent facial nerve.
When your neurosurgeon operated to remove the tumor, their primary directive was to save your life and protect your brainstem. Because these tumors are incredibly sticky and intimately entangled with the facial nerve, the surgeon must painstakingly peel the tumor off the nerve. Even with world-class surgical skill and intraoperative monitoring, the facial nerve can be stretched, severely bruised, or temporarily lose its blood supply. In some cases, to ensure the entire tumor is removed, the facial nerve must be intentionally sacrificed.
When this connection is disrupted, the muscles of the face immediately lose their signal to move, resulting in paralysis.
Cranial Nerves VII & VIII
Relationship
Understanding Your Symptoms (The Sequelae)
Facial nerve injuries from tumor resections are not one-size-fits-all. Your symptoms depend entirely on the severity of the nerve injury and how much time has passed since your craniotomy. We treat all stages of Vestibular Schwannoma sequelae:
Acute Flaccid Facial Paralysis
Occurring immediately after surgery, the affected side of your face loses all muscle tone. Patients often experience:
- A heavy, drooping brow that obstructs vision.
- Complete loss of movement in the cheek and mouth.
- Difficulty articulating speech.
- Inability to eat or drink without spilling (oral incompetence).
Paralytic Lagophthalmos
(Inability to Close the Eye)
This is an immediate medical emergency.
If your facial nerve cannot signal your eyelid to blink, your cornea is exposed to dry air. Without intervention, this leads to severe dry eye, painful corneal abrasions, and potential vision loss. Protecting your eye is always our first surgical priority.
Post-Paralytic Facial Nerve Syndrome (Synkinesis)
If your nerve was bruised but not cut, it will attempt to slowly heal itself over 6 to 12 months. However, the nerve fibers often get "crossed" as they grow back, a condition known as synkinesis. Instead of individual movements, your facial muscles fire all at once. Symptoms include:
- Your eye forcefully squeezing shut when you try to smile or eat.
- A feeling of a "frozen," tight, or heavy face.
- Pain and chronic cramping in the facial and neck muscles.
- An asymmetric, restricted smile.
The Path to Recovery: Advanced Treatments
Whether your surgery was two weeks ago or ten years ago, there are advanced techniques available to improve your facial function and appearance. Drawing on pioneering research and specialized microsurgical techniques, Dr. Nate Jowett offers customized surgical and non-surgical interventions.
To restore a protective blink and prevent blindness, we utilize techniques that go beyond standard upper eyelid weights. Drawing from Dr. Jowett's published research, we frequently perform lower eyelid suspensions to correct lower lid drooping, restoring a natural contour and securing long-term protection for your eye.
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation. With dual fellowship training in Germany and at Harvard Medical School, he brings a unique engineering and microsurgical background to treating complex facial nerve disorders.
Whether you are days into a diagnosis or have lived with incomplete recovery for years, Dr. Jowett offers the full spectrum of care, from medical management to cutting-edge surgical reconstruction, to help you regain your smile and confidence.
Selected References
- Long-Term Vestibulocochlear Functional Outcome Following Retro-Sigmoid Approach to Resection of Vestibular Schwannoma. Abboud T, et al. Eur Arch Otorhinolaryngol. 2016 Mar; 273(3):719-25. doi: 10.1007/s00405-015-3561-5. PMID: 25700833.
- Effect of Weakening of Ipsilateral Depressor Anguli Oris on Smile Symmetry in Postparalysis Facial Palsy. Jowett N, Malka R, Hadlock TA. JAMA Facial Plast Surg. 2017 Jan 01; 19(1):29-33. doi: 10.1001/jamafacial.2016.1115. PMID: 27658020.
- A General Approach to Facial Palsy. Jowett N. Otolaryngol Clin North Am. 2018 Dec;51(6):1019-1031. doi: 10.1016/j.otc.2018.07.002. PMID: 30119926.
- A Contemporary Approach to Facial Reanimation. Jowett N, Hadlock TA. JAMA Facial Plast Surg. 2015 Jul-Aug;17(4):293-300. doi: 10.1001/jamafacial.2015.0399. PMID: 26042960.