Facial Nerve Palsy

What Is Facial Nerve Palsy?

Facial nerve palsy is also known as paresis. Paresis refers to a weakness in the facial movement while palsy refers to a complete lack of motion, or facial paralysis. Of course, as a parent, it can be frightening if your child cannot move one or both sides of his face, especially if you don’t know why the palsy has occurred.

Facial nerve palsy can be a congenital deformity (birth defect), or can be acquired at any time in life.

Congenital facial paralysis, or facial paralysis that occurs at birth, can occur on one side of the face (unilateral facial paralysis) or both sides of the face (bilateral facial paralysis). Unilateral paralysis is often a symptom of other defects, such as hemifacial microsomia.

Bilateral cases often result from Moebius (or Möbius) syndrome, which is believed to be related to missing the blood vessels that nourish the facial nerves and muscles.

Acquired facial paralysis occurs when trauma or diseases causes damage to the brain or facial nerves, which can result in temporary or persistent paralysis. If the paralysis persists, surgery may be required to improve facial motion.  

One of the first questions parents ask is if the palsy is permanent. In some cases, facial palsy does improve with time, and the affected child generally regains partial function of his or her face. 

Below describes what you can expect with different types of palsy.

  • Moebius syndrome: generally does not improve with time. 
  • Acquired facial nerve palsy: children (and adults) can expect improvement when tumors that compress the nerves are removed releasing pressure on the facial nerves. 

Causes of Facial Nerve Palsy

If a child is born with facial palsy, one may feel guilty or wonder if the paralysis could have been prevented. Researchers agree that most often concerning congenital facial nerve palsy, there is nothing that could have been done or changed. It is very rare for facial nerve palsy to be passed on genetically. Sometimes the blood vessels that are responsible for nourishing the facial nerves and muscles do not form, though the reason is still unknown.

Facial motion begins with the brain where signals are sent from the brain through the facial muscles. The facial nerve begins as a single trunk of nerves in the skull and begins to branch out to the many facial muscles once it leaves the skull. These nerves control many facial functions, including smiling, frowning, blinking, and more.

In acquired facial nerve palsy, there are over 100 known causes. Some of these causes include:
  • Head injury (concussion)
  • Disease to the facial nerves and brain
  • Cuts in the facial nerve 
  • Damage to the facial muscles that produce motion
  • Brain surgery (tumor removal)
  • Tumors in the head and neck
  • Inflammatory and infectious diseases, such as Lyme disease
  • Stretching to the nerves and muscles during birth
  • The use of forceps during birth

Features of Facial Nerve Palsy

If you think your child may have facial nerve palsy, he or she may experience:
  • Partial or full paralysis of one or both sides of the face
  • Inability to close eyelids on side with palsy
  • Inability to move mouth on side with palsy
If your child was not born with facial nerve palsy, you may notice that your child was fine one day and not the next. These symptoms can have a sudden and unexpected onset after an injury, trauma at birth, or from the growth of a tumor, or inflammation, as in the case of Bell's Palsy.

Additional issues may include:
  • Facial sagging: When children have facial nerve palsy, the elasticity in their skin generally prevents excessive sagging in the face. Adults, however, generally show sagging immediately in the face.
  • Eyelids: The ability to close the eye may be impaired, increasing the possibility of injury to the eye. Eye protection and lubrication is important. 
  • Sucking and chewing: The normal process of sucking, drinking, and chewing may be inhibited. Drooling may also become an issue. 
  • Imbalanced smile: Because one side of the mouth generally will not move, the result is a lopsided smile. Many children avoid smiling.  
This list should be used as a guideline. Not every symptom is included. If your child has one or more of these symptoms, it does not mean that he or she has facial nerve palsy. If you are concerned that your child might have facial nerve palsy, please make an appointment with your child's doctor.

Because your child’s condition may be a symptom of a more complex syndrome, we use 3D CT or MR Scan imaging to provide a diagnosis more quickly and with more accuracy than ever before. In this way, we can better understand how your child’s birth defect will specifically impact his or her health and development. 

Treatments for Facial Nerve Palsy

By gathering accurate data, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor your child’s condition during the post-surgical healing process
  • Monitor your child’s long-term development

Surgery for unilateral facial paralysis
Because it is frightening to see one or both sides of your child’s face paralyzed, it is natural to wonder if the condition will be permanent. In some cases, the palsy will resolve on its own. In other cases, surgery may be required.

Our craniofacial team brings together top surgeons from multiple disciplines to offer you and your child comprehensive care.

When facial paralysis is on one side of your child’s face, one procedure that can be used is cross-facial nerve grafting. This procedure involves a graft from the unaffected side to the affected side. A donor nerve is used from your child’s leg. In a later surgery, a donor muscle is also taken from the leg and is transplanted into the face and connected to the transplanted nerve. 

Surgery for bilateral facial paralysis
If your child has paralysis on both sides of his face, a donor muscle from the leg is transplanted to one side at a time, using a nerve that assists with chewing rather than harvesting nerves from the leg. The second transplant can generally be done a few months after the first transplant surgery. An incision along the hairline is used because it usually heals well into a thin, flat scar.