Facial palsy in children and young adults

Rare congenital craniofacial clefts, trauma, infection, neoplasms, and several other congenital etiologies can be accompanied with varying degrees of facial paralysis. Children and adolescents have unique clinical characteristics of facial palsy and functional impairment that are different from adults. Patients with complete facial paralysis will most notably have asymmetry both in repose and during animation. In the pediatric population, asymmetry is more noticeable during smiling or crying. Surprisingly, likely due to the tone and skin elasticity in the young population, the differences between the paralyzed and non-paralyzed sides in repose are less prominent. Brow ptosis, lower eyelid malposition, and a depressed modiolus in children and young adults are less noticeable compared to older patients. Several modalities of treatment may be used singularly or in combination including surgery, botulinum toxin injections, and physical therapy. In the most common scenario in children with complete facial palsy the mainstay of treatment is surgery. Surgical treatment may be categorized as dynamic or static reanimation procedures. Dynamic reanimation of facial palsy in children frequently occurs as a two stage procedure with cross facial nerve grafting followed by functional free muscle transfers. In circumstances when the contralateral facial nerve is not available, a one stage procedure using the masseteric nerve for innervation of a functional free muscle transfer is performed. In this chapter, clinical characteristics, anatomy of the facial nerve, special considerations, and treatment options for children with facial paralysis are detailed.