Liliana J. Ein, M.D., leads the new Facial Nerve Program in the Department of Otolaryngology, Head and Neck Surgery at University of Miami Health System.
Though facial nerve disorders are common, few academic and other centers offer the advanced training required to successfully address these conditions.
Dr. Ein, who completed a fellowship in the facial plastic and reconstructive surgery subspecialty of facial reanimation at Massachusetts Eye and Ear, a Harvard Medical School teaching hospital, treats patients with any type or degree of facial paralysis.
“The facial nerve controls the muscles of facial function and expression,” said Dr. Ein, an assistant professor of clinical otolaryngology. “When any type of disorder affects the facial nerve, people may not be able to blink, smile, or hold food in their mouth.
“The goal of our program is to provide all of these patients with specialized care, from surgery to physical therapy.”
Facial paralysis may stem from any of an array of conditions and can affect people of all ages, from infants to the elderly. The most common cause is Bell’s Palsy, which causes sudden-onset facial paralysis. Others include head trauma, autoimmune disorders, and congenital nerve or muscle problems.
“Because the hearing nerve and the balance nerve are right next to the facial nerve, benign tumors growing on those nerves sometimes affect the facial nerve,” Dr. Ein said. “Cancers can also affect the facial nerve, as can infections such as Lyme disease or viruses like varicella zoster.”
Timely Treatment Improves Quality of Life
“Patients living with paralysis of the face cannot hide their condition, so helping to restore some function as quickly as possible is of paramount importance,” said Fred F. Telischi, M.D., James R. Chandler Chair in Otolaryngology and professor of neurological surgery and biomedical engineering at the Miller School of Medicine.
“With the recruitment of Dr. Liliana Ein directly from her fellowship at Harvard, we now have an anchor facial reconstructive surgeon for disorders related to facial paralysis. Dr. Ein has experience with all aspects of facial weakness and will develop the most comprehensive team in the region to manage these patients.”
Dr. Ein was an otolaryngology resident at the Miller School when she first realized the great need for this type of care. While surgeons could, for example, successfully remove head and neck cancers and benign tumors, patients were often left with some degree of facial paralysis.
“We may have cured their cancer or removed the tumor on their hearing or balance nerve, but now they are living with the psychosocial repercussions of having facial paralysis,” Dr. Ein said. “I remember one patient telling me that he had to stay at home in a dark room because he couldn’t blink his eye and didn’t want to go out in public because of the way he looked. That’s when I started to research facial reanimation.”
That, in turn, led to a fellowship in 2020 with Tessa Hadlock, M.D., professor of otolaryngology – head and neck surgery at Harvard Medical School, a renowned clinician, investigator, and advocate for facial palsy patients.
While Dr. Ein had originally planned to do a head and neck cancer fellowship, “I switched gears when I realized how few people had facial reanimation training,” she said. “Typically, because it is such a specialized field, facial paralysis is treated within a tertiary care university setting. The new Miller School program is one of a select few academic facial nerve programs.”
Today Dr. Ein treats facial paralysis patients in collaboration with Miller School head and neck cancer physicians, neurosurgeons, neuro-otologists, trauma specialists, and others. “My colleagues will take care of the cancer or other condition, and I will reconstruct the nerve,” she said.
Dr. Ein is also training Miller School physical therapists in the treatment of patients with facial paralysis. “It is a very different type of physical therapy than what physical therapists are usually trained in,” she said.
The Facial Nerve Program brings a new subspecialty dimension to the Miller School’s Department of Otolaryngology – Head and Neck Surgery.
“It broadens and strengthens us from the perspectives of both training and patient access,” Dr. Ein noted. “When I was at Harvard, I saw many patients from Miami who had been referred by doctors at the Miller School. Now I can take care of them closer to home.”