Facial Nerve Preservation:
why are facial problems still possible?

A doctor's explanation:

Q: Dr. Cohen, can you explain why, in many cases, the facial nerve was preserved and the monitoring showed that there was no damage, but the patient had facial paralysis?

A: Dr. Cohen: It points out a couple of things. One is that monitoring is not infallible. Although you've left the nerve antatomically intact, and you stimulate it and get a response, that response depends to a certain extent on how much monitor electricity you put into the nerve. If you put in a large enough current, you're going to get an electrical response at the end of the operation, whereas physiologically the nerve is not able to work.

The medical literature:

Current state of the art (i.e., the best surgeons) have preservation of the facial nerve in between 82 and 97% of cases.


The rate of immediate (temporary as well as permanent) facial weakness (not necessarily total paralysis) after microsurgery of  tumors up to 3cm is approximately 50% (the statistic is worse for larger ones).

Patient's stories:

I had my surgery 3 years ago and my facial nerve was saved, but my eye still doesn't blink, my taste is messed up and although I have some tone in my face so that my face doesn't droop, I still have paralysis.  Also, I am still battling fatigue.

My surgery was October, 1997. My surgeons took the time they needed to preserve the nerve, so that it will completely repair itself eventually. In the meantime (6 months later), the facial sag is a drag, and the worst part is not being able to blink my right eye.

I have facial paralysis from removal of an AN in July 97. The facial nerve was not severed but badly stretched and scraped thin.

Last Edited: Wednesday, October 30, 2002