Expediting care for adults and children with ocular impacts from facial paralysis

Dr. John Ng examines a patient with colleagues in the background.
John Ng, M.D., MS, FACS, is an orbital surgeon with expertise in ophthalmic plastic, orbital, lacrimal and reconstructive surgery for adult and pediatric patients. He is pictured here with other members of the Facial Nerve Center team during their multidisciplinary clinic at Casey Eye Institute.

Facial Nerve Center is the only place in Oregon to offer cutting edge facial reanimation surgery

The OHSU Facial Nerve Center housed inside the OHSU Casey Eye Institute offers multidisciplinary treatment for children and adults with facial nerve disorders. Our team includes some of the top experts in the nation in facial reconstructive and plastic surgery. John Ng, M.D., MS, FACS, chief of the Division of Oculofacial Plastics, Orbital and Reconstructive Surgery is the co-director of the center with reconstructive facial plastic surgeon and otolaryngologist Myriam Loyo Li, M.D.

“Facial paralysis is a fairly common issue, and one that has profound psychosocial effects,” Ng said. “For maintaining eye health, the best care is early care. By centralizing all services in one physical location, we treat children and adults holistically, avoiding fragmented care and unnecessary delays for patients. Our collaborative team evaluates each patient and determines a care plan. A combined surgical plan means we can often perform several procedures in one anesthetic operating room session.”

The most common ophthalmic need in facial paralysis is eye protection. Bell’s palsy, stroke and other facial nerve injuries can put the eyes at risk for corneal exposure from sagging lower eyelids and inability to completely close the eyelids. Ng provides medical and surgical procedures to improve these conditions for both temporary and long-lasting facial paralysis. Other nonsurgical therapies available include custom scleral lenses and rehabilitation services.

For patients with prolonged or congenital paralysis, Ng and the Facial Nerve team can provide nerve grafts, neurotized free muscle transfers and facial suspension. OHSU is the only center in Oregon with microsurgical procedures for nerve transfer and free muscle transfers for facial reanimation. Ng performs minimally invasive corneal neurotization, a technique of grafting a healthy donor nerve to the affected eye to restore sensation. Only a handful of centers around the country offer this corneal reinnervation expertise.

For patients with incomplete paralysis, hemifacial spasms and synkinesis, Ng uses selective chemodenervation (i.e., Botox treatments).

“Time is of the essence in facial paralysis,” Ng said. “Our co-managed approach and combined multispecialty clinic all under one roof consolidates patient visits into as few trips as possible. This results in streamlined care that is better for all patients, but especially for those traveling long distances to the center, including most of the western states and Alaska.”

OHSU Facial Nerve Center Team

  • Pediatric plastic and reconstructive surgery
  • Adult facial plastic and reconstructive surgery
  • Otolaryngology surgery
  • Oculofacial plastics, orbital and reconstructive surgery
  • Head and Neck Oncology and Orbital Oncology
  • Speech-language pathology
  • Physical therapy, facial specialty
  • Optometry, contact lens specialty
  • Social work

Central hub for peripheral nerve dysfunction

The Facial Nerve Center is part of the OHSU Nerve Center, which is unique on the West Coast for our multidisciplinary approach to nerve disorders. We bring the collective expertise of neurology, neurosurgery, ophthalmology, orthopedics, otolaryngology/head and neck surgery, physical medicine and plastic surgery to bear on determining the right treatment options for each patient. Additionally, we have support systems for patients in the OHSU Rehabilitation Services, OHSU Comprehensive Pain Center and OHSU Neurology.

Technology and innovation

  • Our specialists use the latest surgical techniques and the most advanced technology available anywhere.
  • Microsurgical techniques to perform reinnervation for motor recovery in facial paralysis and sensory recovery of the cornea.
  • Intraoperative nerve stimulation to precisely identify nerves.
  • Cutting-edge technology for custom contact lenses.
  • Cutting-edge development of treatments for aberrant tearing management (crocodile tearing), including the Jones Tube, Frosted Jones Tube and Narrow Lumen Jones Tube – all invented at OHSU.