Facial Nerve Grafting Post-op Instructions & Care

Director at CHC

Dr. Hammerschlag is on the board of directors and an active provider to the nonprofit, Center for Hearing and Communication, which has been been providing hearing care since 1904.

New York Super Doctor


Facial nerve grafting is utilized to treat facial nerve paralysis when a portion of the facial nerve needs to be replaced or an alternative new nerve supply to the facial muscles is required. The surgery may be performed in the brainstem/skull base behind the ear, ear-mastoid or neck regions, depending on the specifics of your case.

The nerve graft may come from the neck, forearm, or behind the ankle.

After Surgery:

  • The surgery is usually performed under general anesthesia, which means that you will be in the recovery room for a few hours after the surgery. The duration of the surgery will depend on the specifics of your case.
  • You may experience some nausea or dizziness in the recovery room. This usually arises from anesthesia and will pass over several hours. Anti-nausea medication will be given following surgery.
  • You may feel tired and unsteady after general anesthesia – this is normal. Oozing from incisions and mild bruising of the skin around the incisions, usually behind the ear and neck, are also expected. These will improve over several days.

A mild or moderate degree of discomfort is normal following surgery. Most patients have minimal pain and swelling after surgery. You will be given pain medication while in the hospital and afterwards following your discharge.

If you are discharged from the hospital one or more days after your surgery, you may have a drain from the surgical site to reduce swelling, fluid accumulations from the body’s response to surgery and secretions from the salivary gland (parotid gland in front of the ear). This will be removed when the drainage diminishes over the following 24 to 48 hours.

If you are discharged the same day of your surgery, you may have a head bandage dressing, which should be removed the day following surgery and follow the instructions below:

  • It is very important to keep the incision clean with meticulous care using 1/2 strength hydrogen peroxide for crusts or dried blood. Remember to gently clean the wound with soap and water and then gently dry the area. Be sure to wash your hands before cleaning the incision/wound.

You should not get the incision wet for two days after surgery. If the incision is behind the ear, you shower or bathe with a protective shower cap before two days following surgery. You may shampoo your hair after two days following surgery.

You will probably receive an antibiotic with instructions when you are discharged from the hospital. Please take all your medication for the full period, seven to ten days, as instructed.

You may also take Tylenol (acetaminophen) for discomfort. If you are prescribed a pain medication, take it if the Tylenol does not provide sufficient pain relief.

You may be fatigued for several days following your surgery. Your exertions and activities should not be strenuous until you feel stronger. You should be out of bed and walk as much as possible, as your strength permits.

You will have your first postoperative office visit five to ten days after your surgery to remove any sutures (suture or stainless steel staples). Please call the office if you do not have this appointment scheduled at your hospital discharge. After the sutures/staples are removed, you may cleanse the incision with soap and water (dry well).

You will be given further instructions concerning subsequent office visits.

Facial nerve regeneration will occur over several months. The new nerve contents migrate one millimeter a day from the nerve cell body/root at the brainstem. We can see evidence of nerve regeneration as early as four months and as late as 15 months.

Facial muscle massage or electrical muscle stimulation by physical therapy is not necessary. In fact, such intervention sends the wrong biochemical signals to the facial nerve cell bodies to cause them to refrain from nerve regeneration metabolism. The nerve cell bodies start their reparative metabolism/machinery when it receives biochemical signals that the facial muscles do not have nerve activity due to nerve deficiency. Physical therapy is a very important part of facial nerve rehabilitation, but it is best started after appearance of facial nerve regeneration. At that time, your surgeon will order physical therapy.

You will continue to see your surgeon for two years after your surgery because the response of the facial muscles to nerve grafting can continue to progress over this time.

Practice Announcement

Dr. Paul Hammerschlag has retired after a long and distinguished career. His friend and colleague, Dr. Darius Kohan, Associate Professor at NYU School of Medicine and Director of Otology/Neurotology at Lenox Hill Hospital and MEETH, will continue to manage his practice and provide continued care for his patients. Please contact his office at 1-212-472-1300 to schedule an appointment.

Please read Dr. Hammerschlags' full retirement and practice transfer announcement here.

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