When your baby can’t smile: Treatment options for facial paralysis

If your child is smiling or crying with only one side of their face, this could indicate pediatric facial nerve paralysis, also called facial palsy.

Facial paralysis happens when the main nerve in your child’s face is damaged. You may notice one-sided (asymmetrical) movements or drooping in your child’s face. It could also affect how their eyes or lips close. This can cause problems like drooling or eye dryness.

Facial paralysis can happen any time in a child’s life, even before birth. It can also appear slowly as your child grows. Facial nerve paralysis is caused by:

• Conditions infants are born with (called congenital conditions) that cause facial paralysis, such as Moebius Syndrome
• Bell’s palsy, a disorder that causes facial paralysis. While the exact cause of Bell’s Palsy isn't known, it is likely triggered by an infection, immune response or other cause
• Brain tumors that press on the facial nerve or affect the nerve during removal
• Trauma, such as damage to the facial nerve during birth or from a head injury

Some conditions, like Bell’s palsy, may clear up on their own. Your child’s doctor may choose to observe Bell’s palsy over time and prescribe medications to treat any side effects.

If your child’s facial paralysis will not go away on its own, it’s important to seek treatment as soon as you notice a problem.

Treatment for facial nerve paralysis

There are several options to treat facial paralysis, ranging from medications to plastic surgery. This type of surgery is called facial reanimation surgery. When facial paralysis is limited to one small area of the face, a minor procedure may be able to fix the problem.

“Every situation is a bit different. A classic example of a minor procedure is treating congenital paralysis asymmetry in the lower lip, or when a baby’s lip moves on only one side. This can be treated with Botox injections or a smaller operation,” said Dr. Gregory Borschel, a pediatric plastic surgeon at Riley Children’s Health. “We can also perform relatively smaller surgery to improve eyelid closure.”

Dr. Borschel and his team are experts in facial reanimation surgeries. His research is widely published, and he often speaks about this type of surgery at national medical conferences. Families travel from all over the country and the world for this specialized care.

If your child has facial paralysis on one side of their face (unilateral paralysis), your child’s doctor may recommend a facial reanimation surgery called cross-face nerve graft. This two-surgery process implants nerves and muscle from the child’s leg to the face to restore movement. Four to six months after the second surgery, your child’s facial muscles begin moving and continue to improve. This type of surgery is usually very effective and offers patients excellent outcomes.

“These treatment options have been around for a while,” Dr. Borschel said. “We do some new, pioneering operations here at Riley, but most of what we do relies on tried-and-true operations we’ve been doing for years.”

Early intervention for facial paralysis

It’s important to address facial nerve problems as soon as you notice them. Early intervention gives your child more time to recover muscle movement as they grow. Children as young as three can undergo facial reanimation surgery.

“If we can get the face and the brain on the same page early in life, then they’re going to recover better and gain better movement control,” said Dr. Borschel. “This also helps children communicate better and do better socially.”

Talk to your pediatrician or family doctor if you have concerns about your child’s facial movement. You can also contact Dr. Borschel’s team to set up an evaluation. The team at Facial Plastic Surgery at Riley Children’s Health can examine your child’s facial movements in person or via video chat. Schedule a consultation by calling 317.948.0345.