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Facial Reanimation

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What is facial reanimation?

Facial reanimation is a term for procedures that help children move their face or make more even movements on both sides of their face. The Facial Reanimation Program at Seattle Children's Craniofacial Center does facial reanimation for children who have paralyzed face muscles.

A nerve called the facial nerve controls the face muscles. One facial nerve comes out of each side of the skull near the ear. These two main nerves divide into many smaller branches that connect to different face muscles.

Some nerves go to the upper face and control the eyebrows and eyelids. Some go to the middle of the face and control movements like smiling. Some go to the lower face and control the lips.

If the facial nerve or any of its branches does not work, your child will not be able to move some of the muscles in their face. Those muscles will be paralyzed. This is sometimes called facial palsy. Facial palsy usually affects only one side of the face. Some children have a condition that affects both of their facial nerves and both sides of their face.

To help children with facial nerve paralysis, doctors use procedures like these:

  • Eyebrows. If one eyebrow does not move and the other does, doctors may inject Botox into the moving eyebrow to paralyze it. This way the child’s eyebrows match from side to side.
  • Eyelids. If the eyelids don’t close tightly, surgeons may place tiny gold weights inside the upper lid to help pull it down. They may use a small piece of tendon to create a sling that pulls the lower eyelid up.
  • Mid-face. If a child cannot smile, surgeons may take a muscle from the child’s inner leg (gracilis muscle) and move it to the child’s face. They connect one end of this muscle to the cheekbone and the other end to the corner of the mouth. Then they connect the muscle to nerves in the face that do work – nerves from the other side of the face or nerves from other face muscles, such as those that help you chew. This procedure is sometimes called “smile surgery.”
  • Lower lip. If one side of the lower lip does not move and the other does, doctors may inject Botox into the moving side to paralyze it. This makes the lip match from side to side. Another option is to take out the muscle on the moving side.

What’s special about facial reanimation at Seattle Children’s?

At Seattle Children’s we do many types of facial reanimation, including all the procedures listed above. Our program for facial reanimation is the only one of its kind for children in the Northwest.

Each child who comes to Seattle Children’s with a facial nerve problem is assessed by a team of providers from many areas of healthcare. This approach – called "interdisciplinary" – helps us learn about your child’s condition and provide the best treatment. The team may include pediatricians, surgeons, feeding specialists, speech specialists, therapists, radiologists, nurses, social workers and many others.

The exact team for your child depends on your child’s needs. For example, if there’s a problem where the facial nerve comes out of the skull near the ear, your child’s team may include an ear-nose-throat specialist. If there’s a problem with the facial nerve inside the skull, your child’s team may include a neurosurgeon.

Along with providing treatment, the team helps your child adapt to changes in their face, like after “smile surgery.” The members of your child’s team work together closely to coordinate your child’s care.

To help plan treatment, check your child’s growth and measure treatment results, we use the latest technology, like high-definition video and the 3dMD camera. This camera takes a precise, three-dimensional, digital image of your child’s face and head.

Who needs facial reanimation?

Any child who cannot move part or all of their face because of a problem with the facial nerve might benefit from facial reanimation. We treat children with many types of conditions, including these:

  • Craniofacial microsomia, also called hemifacial microsomia
  • Moebius syndrome, also called congenital facial diplegia
  • Traumatic injury to the facial nerve, such as during birth or from an accident
  • Bell’s palsy, in which the facial nerve stops working all of a sudden
  • Facial nerve problems because a tumor near the nerve was removed
  • Other facial nerve problems that children may be born with (congenital) or that may occur later

What are the benefits of facial reanimation?

Children who have facial reanimation procedures may enjoy benefits like these:

  • Facial expression that matches more closely from side to side
  • Fewer problems with dry eyes or extra tears because their eyelids can close tightly
  • Better ability to eat
  • Better ability to speak clearly
  • Better ability to smile, express their feelings through their face and interact with others

How can I make an appointment at Seattle Children’s?

A doctor, like your child’s regular pediatrician, can refer you to our program. You can also call us yourself to find out about making an appointment. Call the Craniofacial Center at 206-987-2208.

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