1 yr update and the "House-Brackmann Facial Nerve Grading System"

[rjp]

A little update, maybe someone will find this useful...

I am 1 year since my surgery.  Had it done at OHSU, in Portland.
I had 3 cm AN on the left side.
Only 75% or so was removed during surgery, before they needed to stop due to face not responding.
So I still have another surgery to look forward to early in 2008. (GK may be possible for balance, but not decided)

Result wa typical loss of hearing, and and unfortuneatly not so typical level 4 facial paralysis for the first 6-8 months.
I was luckly in th sense that I had no leakage and needed no shunt (it was close it took 9 days in ICU before I started to drain naturally).
1 or 2 more days they would have installed a shunt.  So that was lucky.

Well now I am a level 3 according to my doc, so there has been some improvement.   
 Nothing much started to improve until about 7 months.
The big difference between level 4 and level 3, is the ability to close my left eye.

There is some improvement in tone, and some smallimprovements in the movements on mouth.
Forehead still feels dead, as do a small portion of my nose. But seems to be getting better,
but sure is slow!  Pretty crooked smile still.



Here is the House-Brackmann Facial Nerve Grading System
scale in more detail:
------------------------------------------------
I Normal Normal facial function in all nerve branches
 
II Slight 
Gross:  Slight weakness on close inspection, slight synkinesis.
 At Rest: 
Normal tone & Symmetry.
 Motion: 
Forehead:  Good to moderate movement.
Eye: Complete closure with minimum effort.
Mouth: Slight asymmetry.
 
III Moderate 
Gross:  Obvious but not disfiguring facial asymmetry. Synkineisi is noticeable but not severe.  May have hemi-facial spasm or contracture. 
 At Rest: 
Normal tone & Symmetry.
 Motion: 
Forehead:  Slight  to moderate movement.
Eye: Complete closure with effort.
Mouth: Slight weakness with maximum effort.   
 
IV Moderately
Severe 
Gross:  Asymmetry is disfiguring and/or obvious facial weakness.
 At Rest: 
Normal tone & Symmetry.
 Motion: 
Forehead:  No movement.
Eye: Incomplete eye closure.
Mouth:  Asymmetrical with maximum effort.   
 
V Severe 
Gross:  Only slight, barely noticeable, movement.
 At Rest: 
Asymmetrical facial appearance.
 Motion:
Forehead:  No movement.
Eye: Incomplete closure.
Mouth:  Slight movement.
 
VI Total No facial function
------------------------------------------------


Now I am at a level 3.  Doc says I may still get to a level 2, and I hope so.
Level 2, is very hard for people to notice (other than yourself).

At first I couldn't close my eye all the way.  Now I can.
But it still isn't lubricating well, so I am still using the lacrilube, which means I can pretty much only use my good eye.
Lack of eye use been the biggest issue for me currently.


not looking forward to the next surgery, I would hate to lose the progress I have made so far.


rjp

[Victoriah1999]

Oh wow, you've come SUCH a long way!  AWESOME!  Nine days is ICU, WOW.  That is a hecka long time.  I'm sooo glad for you that they did not put the shunt in.  Just more crud to deal with on top of everything else.

Are you doing Physical Therapy or is it time and rest that gives you the best result?  I wonder if an opthalmologist that is familiar with AN's or tumors could possibly help your weaker eye with a pair of glasses?  Just throwing it out there just in case, I am TOTALLY unsure about this but it might be worth a phonecall. 

I am at a level II and as they say:  "Only my Neuro knows for sure."  LOL! 
My husband and I can tell, most especially if I'm having trouble sleeping, but you are correct, most people never notice it.
I really hope you get to II!
I'm thinking I'd grill the doc on GK and how it will be done and how they can plan for the BEST outcome possible.
Not to be maudlin, but I know some docs think that hey, the tumor is gone, you're alive, the rest is cake, you know?  (UGH)
I'd get really specific about the questions and have him (her) map it out and SHOW me where they are zapping the nerve and
what is near it and how might things be affected.

I am actually vain enough to be fine with a little bit of wonky balance but not have my face slide.  :/  I think I was LUCKY to have that outcome, so maybe it's just me. 

Also, thanks for posting this.  I was actually feeling quite bummed about the level of asymmetry lately since I've not been sleeping well.  Just goes to WAKE me up and be once again grateful for my outcome.    You rock!
Sorry if this got too long!  Feeling chatty and upbeat today. 

[4cm in Pacific Northwest]

RJP

It is encouraging to read that there are improvement testimonies.   
At my 11 week post op bench mark today I am still at a 4.4 on the HB scale of things.

I chose the temporary eye weight, that Dr Ng at OHSU offered, over the implanted one as he mentioned that this could resolve and sometimes there are complications with implants.

 I went earlier this week, for one morning only, without it and my eye got too irritated and dried out so I went back to more sticky tape on my face. My eye worked after surgery for 2 days however later it stopped. Today I have 90% closure without the weight stuck on however only 10% blinking action. I prefer to continue longer with the weight stuck on with the double-side-tape.

No change in my facial palsy since week 4.

Your post was the encouragement that I needed to read today… nerve regeneration is a slow process. Being “patient� is challenging…

Thanks for posting your testimony. I got something out of it.

Keep moving forward!

Cheers,

4

[Meagan]

so i was in the icu for 2 months and had so many issues but seeing your lacrilube comment made my month....i pretty much do not have vision in the eye but when the lacrilube comes out...i can kind of see...i believed it was the lacrilube but now can confirm that is what is stopping the vision...thanks!!