Health Library
Facial Paralysis

What is Facial Paralysis?

Facial paralysis occurs when a child cannot move some or all the muscles in the face. The paralysis often affects only one side of the face, but it can affect both sides. When these muscles are paralyzed, it can affect a child’s facial expressions and how they eat, talk, and open and close their eyes.

There are three types of facial paralysis:

  1. Congenital facial paralysis. Congenital means that a baby is born with facial paralysis. In most cases, it is permanent. It is most likely caused by how the baby was positioned in the mother’s uterus during pregnancy. This is the most common type of facial paralysis. It occurs in about 1 in 1000 babies. Most babies with congenital facial paralysis don’t have any other health problems.
  2. Facial paralysis after trauma or surgery. Some people experience facial paralysis after a traumatic injury, or after brain, ear, or jaw surgery. This form of paralysis might be temporary or it could be permanent.
  3. Bell’s palsy. This is a form of temporary facial paralysis that often gets better on its own. The cause of Bell’s palsy is not clear. It may be associated with a viral infection. It is often treated with steroids, antiviral medications, and watchful waiting.

Facial Paralysis Causes

Facial paralysis can be caused by:

  • Position of the baby in the uterus
  • Difficult birth; baby stuck in birth canal
  • Traumatic injury; cut to the face or skull fracture
  • Tumor pressing on a facial nerve
  • Infection
  • Surgery
  • Moebius syndrome – A rare type of congenital facial paralysis that usually affects both sides of the face, especially the muscles that control eye movement and facial expression.

Facial Paralysis Signs and Symptoms

Signs and symptoms of facial paralysis include:

  • One side of the mouth and/or cheek droops
  • Hard time eating or drinking
  • Skin near the eye or eyebrow droops
  • Trouble closing an eyelid

Facial Paralysis Diagnosis

The doctor will examine your child’s face.

For congenital facial paralysis, measurements and photographs will be taken of your child’s face. Your child may need an eye exam to look at the cornea and see if they are experiencing dry eye.

For facial paralysis after trauma or surgery, doctors may wait to see if the paralysis gets better on its own. The doctor might order an electromyogram (EMG). An EMG is a test of the electrical activity in nerves and muscles. It can help show if the nerves and muscles are working normally.

Facial Paralysis Treatment

At Cincinnati Children’s, we use a team approach. Experts from multiple departments work together to create a treatment plan based on each child’s individual needs. Our team has the expertise to treat all types of facial paralysis, whether mild or severe.

Treatment depends on which parts of the face are experiencing paralysis, and what result is needed or desired. We may offer both surgical and non-surgical treatments.

Non-surgical treatments help correct movement patterns in the face and can include:

  • Physical therapy including facial movement exercises.
  • Botulinum toxin (Botox) injections to relax the facial muscles.
  • Steroid medicine to reduce inflammation and limit nerve damage.

Surgical treatments include:

To restore the ability to blink

Gold weight insertion
Some children can’t completely close their eye. This can lead to dry eye, which can cause problems with vision and the overall health of the eye. To treat this problem, we can surgically insert a gold weight in the eyelid. This causes the eyelid to close because of gravity. The muscle that opens the eyelid will still work. This results in fewer problems with dry eye and helps prevent eye injuries.

To restore a smile

Cross face nerve graft
When there is paralysis on one side of the face, the smile can be asymmetrical or not the same on both sides of the face. If the paralysis is due to trauma or surgery, sometimes it’s possible to do a nerve graft from the other side of the face. This surgery can be done at any age when the paralysis is due to injury.

In this surgery, we take a healthy nerve from the non-paralyzed side of the face and connect it to the other side of the face using a graft from the leg. The healthy nerve is connected to the paralyzed facial muscle. As the nerve graft heals, muscle function slowly returns. It can take anywhere from six to twelve months to see results after nerve grafting. If paralysis has been present for more than two years it is usually not possible for the muscle to regain function, and a muscle transfer is usually necessary.

Free functional gracilis muscle transfer
In some cases of facial paralysis, the muscle no longer functions. In these cases, we can perform a muscle transfer surgery. You may also hear this called facial reanimation. This involves removing a muscle from the leg (the gracilis muscle, which is in the inner thigh) and transferring it to the face. As the repair heals, the muscle regains function, restoring movement in the face. It is a complex surgery with good success rates.

It can take from four to six months to see results after this surgery. Children must be at least age 10 to have this surgery.

Weakening of the lip depressors
Some kids have problems with paralysis in the lower lip. In these cases, the muscles in the functional side of the lip appear to work too much. To treat this, we start by giving botulinum toxin (Botox) injections to weaken the normal side of the lip. This can make a child’s smile symmetrical again.

If the Botox injections make a big difference, we can do a surgery to divide the muscles inside the mouth. This permanently weakens the non-paralyzed side of the mouth. The result is a more balanced smile.

Long-term Outlook

Children who are treated for facial paralysis have a good long-term outlook. Cincinnati Children’s has high success rates with these treatments. After treatment, kids often have more self-confidence, feel better about themselves, and are happy with the results.

Children will continue to return for follow-up visits as needed.

Last Updated 11/2020

Reviewed By Ann R. Schwentker, MD

Conditions and treatments.

The Division of Plastic Surgery at Cincinnati Children’s provides state-of-the-art-treatment plans, surgical repair and reconstruction for children and adolescents with a variety of conditions.