Facial nerve paralysis (facial nerve palsy)

Among the 12 nerves that grow directly out of the brain—known as the cranial nerves—it’s the seventh nerve that makes it possible for a child to smile, frown and even raise her eyebrows, puff out her cheeks and blink her eyelids.

This nerve, called the facial nerve, runs from the brain behind the ear and down into the parotid gland (large salivary gland) inside the cheek. At that point, it splits off into separate branches that control different muscles throughout the face.

When a child’s facial nerve is damaged, does not work properly or is not completely formed, facial nerve paralysis, also referred to as facial nerve palsy, can result. Facial nerve paralysis:

• can be either congenital (present at birth) or acquired (occurring because of trauma, infection, injury or as a complication of another disease or disorder)
• sometimes happens for no known reason
• most often affects the eyes or mouth
• can cause self-esteem and social issues for children as they grow
• can usually be managed and improved to some degree  

There are several medical diagnoses that can accompany facial nerve paralysis, including:

• Guillain-Barre syndrome
• Moebius syndrome
• Bell’s palsy, a disorder—often linked to the herpes virus—in which inflammation temporarily stuns the nerve
• Lyme disease
• sarcoidosis
• Asymmetric Crying Facies, a minor birth defect that causes a lopsided appearance of the lower lip because the muscle controlling the lip is weak or underdeveloped on one side
• Cayler cardiofacial syndrome, a very rare condition in which a child is born with both congenital heart defects and a weak or missing muscle that controls his lower lip
• Congenital Unilateral Lower Lip Paralysis, a condition in which one side of the child’s lower lip is weak
• poliomyelitis (polio)
• hemifacial microsomia

Treatment options for your child will depend on his age, his symptoms, the degree of facial paralysis he is experiencing and any associated condition he may have. Typically, treatment for facial nerve paralysis will range from surgery to non-invasive support services to a combination of the two.

Here at Children’s Hospital Boston, we will bring together experts across medical disciplines to evaluate your child’s specific needs and circumstances. We recognize your child as an individual—never “just a patient”—and we will involve you in the treatment process at every step of the way.

How Children’s Hospital Boston approaches facial nerve paralysis

Children’s has a long and distinguished history of caring for children with craniofacial anomalies and nerve disorders. Clinicians in our Department of Plastic and Oral Surgery are regarded as international leaders in understanding and treating complex conditions that affect:

• facial appearance and function
• nursing/feeding
• chewing and swallowing
• speech and language

In particular, Children’s has a dedicated Facial Reanimation Program that treats all aspects of facial nerve paralysis and paresis (partial paralysis). Our multidisciplinary team approach involves:

• plastic surgeons, doctors trained to perform procedures that repair deformities or reconstruct parts of the face or body
• oral and maxillofacial surgeons, experts who surgically repair defects or disorders of the mouth, jaw, gums and teeth
• pediatric dentists, health professionals trained to diagnose and treat teeth and gum problems in children and adolescents
• pediatric orthodontists,experts in correcting irregularities in children’s teeth, jaws and “bite”
• nursing professionals with particular expertise in caring for children with facial nerve disorders and deformities
• speech-language pathologists,health professionals who help children and adolescents compensate for and overcome speech, language, feeding and swallowing impairments
• child and adolescent psychologists and social workers, who provide counseling and offer emotional and psychosocial support to children and their families
• when necessary, neurologists and developmental pediatricians who treat related intellectual and learning disabilities
• otolaryngologists and neurosurgeons for treatment of any tumors

Our caring professionals also understand that a lack of facial expression can cause a variety of functional and social problems for your child. That's why we make it our mission to offer the most advanced and effective means of managing symptoms—so that your child can live an active, fulfilled and happy life.

 Facial nerve paralysis (facial nerve palsy): Reviewed by Amir Taghinia, MD
© Children’s Hospital Boston; posted in 2011