The goals of treatment are to improve the symmetry and movement of the affected face.
Eye: Early treatment may focus on protection of the affected eye to ensure the eyelid is closing tightly enough to prevent dryness and permanent damage to the eye. Surgical treatments may involve nerve grafting, procedures to support the lower lid, use of a gold weight in the upper lid to restore blink function and other procedures.
Smile: “Facial reanimation” refers to complex surgical techniques to restore movement to the paralyzed facial muscles. In particular, surgery to restore a child’s smile may help with speech, oral competence and social interactions.
Techniques: Facial reanimation is accomplished using specialized microsurgical techniques to transplant part of a portion of an inner thigh muscle (gracilis) to the face. By connecting the gracilis muscle to working blood vessels and nerves in the face, it allows the muscle to perform functions of smile and elevation of the corner of the mouth. The muscle is removed through a short incision in the upper middle thigh that is hidden in most clothes. To place the muscle in the face, a “face lift” incision hidden in the hairline and ear crease is utilized.
Facial reanimation surgery may be performed in 1 or 2 stages depending upon your child’s condition and may be performed around age 5 or older. After the surgery, intensive occupational therapy will be required to help your child achieve the best possible function.
1-Stage approach: This approach uses the nerve for chewing (masseter nerve) to power the gracilis muscle. Here microsurgical techniques can connect the nerves and blood vessels of the gracilis muscle to the face in a single surgery. While the advantages are a single surgery and earlier results, the smile with this surgery is not as spontaneous as the 2-stage approach.
2-Stage Approach: The 2-stage approach uses the healthy facial nerve on one side of the face to power the gracilis muscle. In the first stage, a nerve from the calf (sural nerve) is attached to the healthy facial nerve and used as a graft for the healthy facial nerve to grow through. 6 to 12 months later when the nerve has grown across the face, the gracilis muscle is ready to be transplanted to the face using microsurgical techniques.