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Learn about facial nerve paralysis and facial reanimation from Amir Taghinia, MD.

Facial Nerve Paralysis | Symptoms & Causes

What causes facial nerve paralysis?

When facial nerve paralysis is congenital (present at birth), it may be related to:

  • Moebius syndrome
  • 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
  • hemifacial microsomia

However, it’s important to note that most often children are born with facial nerve paralysis (typically affecting one side only) that has no identifiable cause.

What causes acquired facial nerve paralysis?

Children can develop facial nerve paralysis later in life because of:

  • certain medical disorders, including:
    • Guillain-Barre syndrome
    • Bell’s palsy, a disorder often linked to the herpes virus in which inflammation damages the muscles on one side of the face
    • Ramsay Hunt syndrome, an infection of the herpes zoster virus (shingles) that compromises the part of the facial nerve near the ear
    • Lyme disease
    • sarcoidosis
    • poliomyelitis (polio)
    • trauma, especially skull fractures
    • chronic or severe episodes of otitis media (infection of the middle ear)
    • tumors that affect any part of the facial nerve

What are symptoms of facial nerve paralysis?

Symptoms may vary from child to child, but often include:

  • asymmetric or “lopsided” appearance of the eyes, mouth, or an entire side of the face
  • excessive drooling
  • food or liquid falling out of the child’s mouth when she tries to eat or drink
  • difficulty closing the eyes/blinking
  • inability to make normal expressions (smiling, frowning, raising the eyebrows)
  • pain around or behind one ear
  • excessive sensitivity to loud sounds

Facial Nerve Paralysis | Diagnosis & Treatments

How do we treat facial nerve paralysis?

Your clinician will advise you on the best course of treatment for your child. Some of the commonly used treatment approaches for facial nerve paralysis include:


Children whose facial nerve paralysis has been brought on by inflammation (for example, because of Bell's palsy or sarcoidosis) may benefit from drugs, including:

  • corticosteroid medications: taken orally, these medications reduce inflammation and help control severe symptoms
  • non-steroidal anti-inflammatory drugs (NSAIDs): taken orally, these medications also help control inflammation and symptoms without some of the side effects of other steroids
  • immunosuppressive medications: drugs that help suppress the hyperactivity of a self-sabotaging immune system

Your child's doctor will advise you as to whether medication might be a good addition to the treatment plan.

Static slings

In some cases, a plastic surgeon may elect to create what is called a static sling — a piece of the child's own tissue that is transplanted in order to prop up the drooping skin around the lips (the “smile area”) or eyelids.

‘Smile surgery’

You may have read or heard about a procedure called “smile surgery” or “the smile operation,” also known as functional muscle transfer. This is an operation that takes muscle from elsewhere in the child's body (usually the thigh) and grafts it onto the corners of his mouth, giving him the ability to smile.

Feeding and nutritional support

Some infants who are born with facial nerve paralysis are unable to nurse properly because they can't form the right “suck” expression. These babies require alternatives to traditional breastfeeding, which may include:

  • special bottles
  • nipple shields
  • feeding tubes
  • syringe feeding
  • spoon feeding
  • dropper feeding

Treating vision problems

Since some children with facial nerve paralysis cannot blink properly, they are at risk for developing dry eye. Regular use of eye drops and regular taping of the eye is usually effective in managing this complication. If eye drops and taping aren't enough, doctors may recommend a procedure called tarsorrhaphy, or placement of gold weight in the upper eyelid, that partially closes the lids.

Speech-language therapy

Facial expressions are critical to any child's relationships with the world around him. Whether he is at home, at school, or in another social setting, his interactions with others depend on his ability to convey his feelings (and respond to theirs). For these reasons, facial nerve paralysis can carry a particular set of challenges.

The good news is that, no matter his degree of facial nerve paralysis, your child can learn new ways of communicating how he feels: He can use his body language, physical posture, and tone of voice to compensate. Speech-language pathologists will work with your child to develop and refine these means of communication, as well as helping him improve and control his breathing and swallowing.

Counseling and psychosocial support

Understandably, children with more severe cases of facial nerve paralysis can feel discouraged, different, and “left out.” Because they are unable to fully communicate with their facial expressions, they can be misconstrued as unfriendly, unobservant, or antisocial by people who aren't familiar with their condition.

Counselors, social workers, child psychologists, and other mental health professionals can be a source of crucial support for your child as he learns to live with — and not be defined as — his disease. These experts will work with your child to build up his self-esteem; teach him skills for coping with feelings of frustration, anger, and sadness; and help him find constructive ways of talking about his condition with classmates, teachers, and others.

Your treating clinician will work with you to formulate a customized plan that helps your child reach his fullest potential in school, at home, and in his personal relationships.

Facial Nerve Paralysis | Coping & Support

If applicable, learn more about your child's related disorder:

Helpful links for parents and families

Please note that neither Boston Children's Hospital, the Department of Plastic and Oral Surgery nor the Facial Reanimation Program at Boston Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

Facial Nerve Paralysis | Programs & Services