How reanimation surgery can help restore facial movement after trauma

But if your child experienced trauma or a brain tumor that damaged nerves in their face, doctors can help them regain movement through facial reanimation surgery.

“These families have been through a lot of heavy experiences, like the ICU or major surgery. I tell them right away that dealing with facial reanimation will be nothing like the intensive experience you just went through: It’s much easier,” said Dr. Gregory Borschel, a plastic surgeon at Riley Children’s Health. “Facial reanimation surgery is the happy part where we try to restore something that was taken away.”

What types of trauma cause facial nerve paralysis?

Facial paralysis happens when there’s damage to the facial nerves (or when a child is born without them). Two facial nerves extend from the brain, through the base of the skull and enter the face near the earlobes. These two nerves branch out in the face to control facial movement and sensations.

A head injury that damages the facial nerve could come from an accident or trauma during birth. It can also be caused by a tumor on the facial nerve, such as a facial neuroma or schwannoma. Surgery to remove this tumor can affect the facial nerve, causing paralysis.

Doctors often use reanimation surgery to repair facial paralysis.

How do I know if my child needs facial reanimation surgery, and who will provide this care?

The plastic surgery team at Riley Children’s Health regularly works with other specialized care teams to anticipate when children need facial reanimation surgery. These teams work together to offer the best options for your child’s care.

If your child has experienced an injury that requires facial reanimation surgery, your care team may include people from several specialties:

• Neuro-oncology, or brain cancer care
• Otolaryngology, often known as ear, nose and throat care
• Neurology, which treats the nervous system
• Emergency or trauma care to treat traumatic injuries
• Plastic surgery to restore function and appearance after trauma
• Facial rehabilitation therapy and speech therapy to help support recovery

Other medical team members may support your child through these surgeries. Ask your care team if you have any questions about who is treating your child.

What can we expect from facial reanimation surgery?

If your child’s facial nerve is damaged and can be repaired, a plastic surgeon will talk to you about facial reanimation surgery options. These can include minor procedures, like fixing a drooping eyelid or lip. It can also describe a cross-facial nerve graft. This two-part surgery implants nerves and muscles from your child’s leg to rebuild the facial nerve. Children as young as three can have a cross-facial nerve graft if they have available nerves and blood vessels for the surgery.

“This type of surgery is much less invasive than the surgeries the child had to treat a tumor or head trauma,” Dr. Borschel said. “The recovery is a lot easier, too. Nerves regenerate slowly, so it can take nine to 12 months after the surgery for the child to regain movement in the face. This will continue to improve over time.”

What other support will my child need after facial reanimation surgery?

Depending on where a tumor or trauma happened in your child’s face or skull, nerve damage can affect speech and balance, too. After facial reanimation surgery or other procedures, your child may work with a physical therapist or facial rehabilitation therapist to strengthen and control their new nerves.

“Many children do very, very well with rehabilitation and recovery,” Dr. Borschel said. “Ultimately, the results can be quite good after a brain tumor.”

When should my child have facial reanimation surgery after a facial trauma?

Many factors affect when your child should have facial reanimation surgery. Sometimes it happens at the same time as the initial trauma treatment. But typically, your child has an initial surgery or treatment to address the tumor or trauma, and then a plastic surgeon like Dr. Borschel is asked to evaluate your child for facial nerve repair.

Once your child’s care team recommends facial reanimation surgery, it is important to have this procedure sooner rather than later. While it’s challenging to confront another surgery when your child has undergone so much to treat a facial trauma, their recovery and movement results are better when the nerves are treated sooner.

“Recovery is a long but rewarding road, and it’s worth it for these kids,” Dr. Borschel said. “Even though it’s daunting to face another procedure, it’s a good idea to try to address facial paralysis surgically. The sooner it’s done, the sooner your child can go on living their life.”