eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Congenital Facial Paralysis: Follow-up

Author: Alan D Bruns, MD, FACS, Chief, Department of Surgery, Evans Army Community Hospital; Clinical Assistant Professor of Surgery, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Oct 16, 2009

Outcome and Prognosis

More than 90% of patients with facial nerve paralysis caused by trauma recover without treatment. When the palsy is of developmental origin the parents should be informed that the child will never have an entirely normal appearance. The best outcome expected in these cases is facial symmetry at rest, near symmetry with voluntary movement, and spontaneous emotive movement.

Future and Controversies

Much controversy exists regarding the timing of facial reanimation and the need for surgical exploration in children with congenital facial paralysis. Issues regarding the timing of reanimation are complex. Some health professionals advocate initial surgery during preschool to prevent the psychosocial aspects associated with a physical abnormality. However, waiting until adolescence when facial growth is mature and the child is able to understand the risks and benefits of surgery and participate in the decision making process also has merit.

No uniform assessment of facial function exists. The House-Brackmann scale is the most widely used, but it has only fair interrater reliability. A standardized program has been developed to permit data entry for facial function that simultaneously produces scores for each of the 6 most commonly used scales. This may progress to a method of acquiring videographs to quantify motion of relevant points of the face to provide a 3-dimensional surface scan to assist in evaluated surgical reanimation surgery.

A web-based data gathering and centralized analysis program with data and “face grams” has also been suggested because the patient population in any given program is small. This would then provide a larger pool of patient for randomized, double-blind studies to determine the effects of steroids or other treatments, thereby creating a better exchange of surgical ideas and innovations.

Other research on nerve growth will also improve clinical outcomes of facial paralysis patients in the future.40

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Kim Lundstrom, MD, to the development and writing of this article.



More on Congenital Facial Paralysis

Overview: Congenital Facial Paralysis
Workup: Congenital Facial Paralysis
Treatment: Congenital Facial Paralysis
Follow-up: Congenital Facial Paralysis
Multimedia: Congenital Facial Paralysis
References
[ CLOSE WINDOW ]

References

  1. Evans AK, Licameli G, Brietzke S, Whittemore K, Kenna M. Pediatric facial nerve paralysis: patients, management and outcomes. Int J Pediatr Otorhinolaryngol. Nov 2005;69(11):1521-8. [Medline].

  2. Falco NA, Eriksson E. Facial nerve palsy in the newborn: incidence and outcome. Plast Reconstr Surg. Jan 1990;85(1):1-4. [Medline].

  3. May M, Schaitkin BM, Shapiro A. Facial nerve disorders in newborns and children. In: May M, Schaitkin BM. The Facial Nerve. 2nd. New York, NY: Thieme; 2000:339-65.

  4. Hughes CA, Harley EH, Milmoe G, Bala R, Martorella A. Birth trauma in the head and neck. Arch Otolaryngol Head Neck Surg. Feb 1999;125(2):193-9. [Medline].

  5. Mchugh HE. Facial Paralysis in birth injury and skull fractures. Arch Otolaryngol. Oct 1963;78:443-55. [Medline].

  6. Sapin SO, Miller AA, Bass HN. Neonatal asymmetric crying facies: a new look at an old problem. Clin Pediatr (Phila). Mar 2005;44(2):109-19. [Medline].

  7. Shapiro NL, Cunningham MJ, Parikh SR, Eavey RD, Cheney ML. Congenital unilateral facial paralysis. Pediatrics. Feb 1996;97(2):261-4. [Medline].

  8. Verzijl HT, van der Zwaag B, Cruysberg JR, Padberg GW. Möbius syndrome redefined: a syndrome of rhombencephalic maldevelopment. Neurology. Aug 12 2003;61(3):327-33. [Medline].

  9. Blanchard K, Winikoff B, Ellertson C. Use of misoprostol during pregnancy and Möbius' syndrome in infants. N Engl J Med. Nov 19 1998;339(21):1553-4. [Medline].

  10. Kankirawatana P, Tennison MB, D'Cruz O, Greenwood RS. Möbius syndrome in infant exposed to cocaine in utero. Pediatr Neurol. Jan-Feb 1993;9(1):71-2. [Medline].

  11. Smets K, Zecic A, Willems J. Ergotamine as a possible cause of Möbius sequence: additional clinical observation. J Child Neurol. May 2004;19(5):398. [Medline].

  12. Cattaneo L, Chierici E, Bianchi B, Sesenna E, Pavesi G. The localization of facial motor impairment in sporadic Möbius syndrome. Neurology. Jun 27 2006;66(12):1907-12. [Medline].

  13. Carvalho GJ, Song CS, Vargervik K, Lalwani AK. Auditory and facial nerve dysfunction in patients with hemifacial microsomia. Arch Otolaryngol Head Neck Surg. Feb 1999;125(2):209-12. [Medline].

  14. Puñal JE, Siebert MF, Angueira FB, Lorenzo AV, Castro-Gago M. Three new patients with congenital unilateral facial nerve palsy due to chromosome 22q11 deletion. J Child Neurol. Jun 2001;16(6):450-2. [Medline].

  15. Aramaki M, Udaka T, Kosaki R, et al. Phenotypic spectrum of CHARGE syndrome with CHD7 mutations. J Pediatr. Mar 2006;148(3):410-4. [Medline].

  16. Meyerson MD, Lewis E, Ill K. Facioscapulohumeral muscular dystrophy and accompanying hearing loss. Arch Otolaryngol. Apr 1984;110(4):261-6. [Medline].

  17. Roedel R, Christen HJ, Laskawi R. Aplasia of the depressor anguli oris muscle: a rare cause of congenital lower lip palsy?. Neuropediatrics. Aug 1998;29(4):215-9. [Medline].

  18. Udagawa A, Arikawa K, Shimizu S, et al. A simple reconstruction for congenital unilateral lower lip palsy. Plast Reconstr Surg. Jul 2007;120(1):238-44. [Medline].

  19. Pastuszak AL, Schuler L, Speck-Martins CE, et al. Use of misoprostol during pregnancy and Möbius' syndrome in infants. N Engl J Med. Jun 25 1998;338(26):1881-5. [Medline].

  20. Bergman I, May M, Wessel HB, Stool SE. Management of facial palsy caused by birth trauma. Laryngoscope. Apr 1986;96(4):381-4. [Medline].

  21. Terzis JK, Noah ME. Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg. Jun 1997;99(7):1905-21. [Medline].

  22. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. Apr 1985;93(2):146-7. [Medline].

  23. Carpenter, MB. Carpenter's Human Neuroanatomy. 9th. Williams and Wilkins; 1996.

  24. Jyonouchi S, McDonald-McGinn DM, Bale S, Zackai EH, Sullivan KE. CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness) syndrome and chromosome 22q11.2 deletion syndrome: a comparison of immunologic and nonimmunologic phenotypic features. Pediatrics. May 2009;123(5):e871-7. [Medline].

  25. Jemec B, Grobbelaar AO, Harrison DH. The abnormal nucleus as a cause of congenital facial palsy. Arch Dis Child. Sep 2000;83(3):256-8. [Medline].

  26. Ondik MP, Preston T, Towfighi J, Isaacson JE. Unilateral congenital facial nerve paralysis secondary to a benign epithelioid peripheral nerve sheath tumor. Otol Neurotol. Dec 2007;28(8):1091-3. [Medline].

  27. Lin KM, Huang CC, Leung JH. Congenital unilateral facial palsy and internal auditory canal stenosis. Pediatr Neurol. Aug 2008;39(2):116-9. [Medline].

  28. Sasaki M, Imamura Y, Sato N. Magnetic resonance imaging in congenital facial palsy. Brain Dev. Mar 2008;30(3):206-10. [Medline].

  29. Duval M, Daniel SJ. Facial nerve palsy in neonates secondary to forceps use. Arch Otolaryngol Head Neck Surg. Jul 2009;135(7):634-6. [Medline].

  30. Humphrey CD, Kriet JD. Nerve repair and cable grafting for facial paralysis. Facial Plast Surg. May 2008;24(2):170-6. [Medline].

  31. Mehta RP. Surgical treatment of facial paralysis. Clin Exp Otorhinolaryngol. Mar 2009;2(1):1-5. [Medline].

  32. Ysunza A, Inigo F, Rojo P, Drucker-Colin R, Monasterio FO. Congenital facial palsy and crossed facial nerve grafts: age and outcome. Int J Pediatr Otorhinolaryngol. Jul 1996;36(2):125-36. [Medline].

  33. Terzis JK, Olivares FS. Mini-temporalis transfer as an adjunct procedure for smile restoration. Plast Reconstr Surg. Feb 2009;123(2):533-42. [Medline].

  34. Fatemi MJ, Forootan SK, Habibi M, Pooli AH, Mansoori MJ. Toward shortening interoperation period in two-stage cross facial nerve graft with muscle transfer. Ann Plast Surg. Jun 2008;60(6):639-43. [Medline].

  35. Terzis JK, Olivares FS. Long-term outcomes of free muscle transfer for smile restoration in children. Plast Reconstr Surg. Feb 2009;123(2):543-55. [Medline].

  36. Biglioli F, Frigerio A, Rabbiosi D, Brusati R. Single-stage facial reanimation in the surgical treatment of unilateral established facial paralysis. Plast Reconstr Surg. Jul 2009;124(1):124-33. [Medline].

  37. Rose EH. Autogenous fascia lata grafts: clinical applications in reanimation of the totally or partially paralyzed face. Plast Reconstr Surg. Jul 2005;116(1):20-32; discussion 33-5. [Medline].

  38. Liu YM, Sherris DA. Static procedures for the management of the midface and lower face. Facial Plast Surg. May 2008;24(2):211-5. [Medline].

  39. Silver AL, Lindsay RW, Cheney ML, Hadlock TA. Thin-profile platinum eyelid weighting: a superior option in the paralyzed eye. Plast Reconstr Surg. Jun 2009;123(6):1697-703. [Medline].

  40. Hadlock T. Facial paralysis: research and future directions. Facial Plast Surg. May 2008;24(2):260-7. [Medline].

  41. Akcakus M, Ozkul Y, Gunes T, et al. Associated anomalies in asymmetric crying facies and 22q11 deletion. Genet Couns. 2003;14(3):325-30. [Medline].

  42. Bradbury ET, Simons W, Sanders R. Psychological and social factors in reconstructive surgery for hemi-facial palsy. J Plast Reconstr Aesthet Surg. 2006;59(3):272-8. [Medline].

  43. Chuang DC. Free tissue transfer for the treatment of facial paralysis. Facial Plast Surg. May 2008;24(2):194-203. [Medline].

  44. Cohen SR, Thompson JW. Variants of Möbius' syndrome and central neurologic impairment. Lindeman procedure in children. Ann Otol Rhinol Laryngol. Jan-Feb 1987;96(1 Pt 1):93-100. [Medline].

  45. Fatemi MJ, Forootan SK, Habibi M, Pooli AH, Mansoori MJ. Toward shortening interoperation period in two-stage cross facial nerve graft with muscle transfer. Ann Plast Surg. Jun 2008;60(6):639-43. [Medline].

  46. Govaert P, Vanhaesebrouck P, De Praeter C, Frankel U, Leroy J. Moebius sequence and prenatal brainstem ischemia. Pediatrics. Sep 1989;84(3):570-3. [Medline].

  47. Jyonouchi S, McDonald-McGinn DM, Bale S, Zackai EH, Sullivan KE. CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness) syndrome and chromosome 22q11.2 deletion syndrome: a comparison of immunologic and nonimmunologic phenotypic features. Pediatrics. May 2009;123(5):e871-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

congenital facial paralysis, facial paralysis, facial paralysis in the newborn, isolated facial paralysis, Möbius syndrome, neonatal paralysis, congenital unilateral lower lip palsy, 22q11.2 deletion syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Alan D Bruns, MD, FACS, Chief, Department of Surgery, Evans Army Community Hospital; Clinical Assistant Professor of Surgery, Uniformed Services University of the Health Sciences
Alan D Bruns, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Michael J Biavati, MD, Clinical Assistant Professor of Otolaryngology, University of Texas Southwestern; Private Practice, ENT Care for Kids, Dallas, TX
Michael J Biavati, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.