Overview
The Cleveland Clinic Facial Paralysis Program is comprised of a team of specialists dedicated to the treatment of children and adult patients with facial paralysis. Our team specializes in treatment of complex cases, failed prior attempts at facial restoration with a longstanding expertise in treatment of congenital and acquired facial paralysis.
We provide comprehensive care for treatment of the following problems: asymmetric smile; inability to raise the eyebrow and close the eye; drooling and difficulty breathing.
The goal of surgery to correct facial paralysis is to achieve the best possible function and appearance of the face. A person with facial paralysis should meet with an experienced surgeon who will consider:
- The cause of the paralysis and the areas of the face that are affected.
- The patient’s age, general physical and emotional health.
- The type of procedure(s) most appropriate for the patient.
- The results that the patient expects and hopes for from the procedure.
Causes of facial paralysis in children
- Congenital or birth-related conditions including:
- Neoplastic.
- Traumatic injury.
- Infectious diseases including:
- Neurogenic conditions including:
Causes of facial paralysis in adults
- Trauma.
- Tumors.
- Stroke.
Diagnosis
There are many causes of facial paralysis, and facial paralysis occurs when there is loss of facial movement. Facial paralysis may be unilateral (affecting one side of the face) or bilateral (affecting both sides) and may affect people of all ages. Paralysis may involve the entire face or only a portion of it.
Certain tests are sometimes helpful in diagnosing the cause of facial paralysis or predicting whether it will improve. The role for testing varies on an individual basis.
- Electroneurography (ENOG): ENOG records a muscle signal after maximal stimulus of the facial nerve near the base of the ear. ENOG is useful early after the onset of facial paralysis to predict which patients will have poor recovery of facial movement.
- Electromyography (EMG): EMG may be useful in determining the extent of nerve injury and the potential for spontaneous recovery. EMG may also be used to identify appropriate donor nerves in cases of multi-nerve dysfunction. EMG is most useful after 3 months from the time of onset of facial paralysis.
- Magnetic Resonance Imaging (MRI): Imaging studies may be indicated to visualize the path of the facial nerve in some cases.
Treatment Options
The type of surgical treatment is decided based on the patient's lost function:
- Smiling: functional muscle (gracilis) transfer; cross face nerve graft; static slings.
- Brow elevation: endoscopic brow lift; direct brow lift.
- Eye closure: gold weight; tarsorrhaphy.
- Nasal function: septorhinoplasty; inferior turbinoplasty.
- Facial asymmetry: fat grafting, face lift; facial implants; botulinum toxin.
Our Doctors
Plastic Surgery
Pediatric Neurology
Ophthalmology
Pediatric Oncology
Speech Therapy
Kristin Wagner, MS, CCC-SLP
Appointments & Locations
If you would like to make an appointment with a Facial Paralysis expert please call 216.445.4726.
Locations
Before & After Videos
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Eight year-old girl with right congenital facial paralysis from Moebius syndrome presented for second opinion following a failed reconstruction attempt with cross face nerve graft and free vascularized serratus muscle performed in United Kingdom. We performed a free gracilis muscle innervated by masseter nerve. The patient started showing signs of recovery 3 months after surgery. The results are shown 1 year after facial reanimation performed at Cleveland Clinic.
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Eight year-old girl with right congenital facial paralysis from Moebius syndrome presented for second opinion following a failed reconstruction attempt with cross face nerve graft and free vascularized serratus muscle performed in United Kingdom. We performed a free gracilis muscle innervated by masseter nerve. The patient started showing signs of recovery 3 months after surgery. The results are shown 1 year after facial reanimation performed at Cleveland Clinic.
