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What causes congenital facial paralysis?

The causes of congenital facial paralysis can be genetic, related to syndromes, or linked to in-utero or birth trauma. Distinguishing between genetic conditions or syndromes and trauma involves observing for signs of recovery, as birth trauma and positioning issues may result in some degree of recovery. In the modern age, genetic mutations or syndromes are more common causes and birth trauma is less often suspected to cause facial weakness when present from birth.

Facial Weakness and Syndromes

Some patients have been born with weakness on one or both sides of the face. Syndromes that commonly are associated with facial weakness include the following:

  • Goldenhar’s Syndrome/hemifacial microsomia: One side of the face is underdeveloped and does not grow normally. “Hemifacial” means one side of the face. “Microsomia” means smallness. 
  • CHARGE syndrome association: This condition affects the senses, including hearing, vision, and balance, and can affect facial motion.
  • VACTERL syndrome: A disorder affecting several body areas, including facial motion. 
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Diagnosis and treatment for congenital facial paralysis

Every case of congenital facial paralysis is unique and managed accordingly. Many patients do well from a developmental standpoint and may not require intervention until they reach school age and express interest in achieving facial balance or a more meaningful smile. Remarkably, children born unable to close an eye adapt easier than adults who lose this function later in life. Treatment options for congenital facial paralysis in children range from simple injections to weaken the overactive healthy side of the face to surgical procedures to restore a dynamic smile.

Physical therapy also plays a crucial role in optimizing function for children, and by age four, children can fully participate in such exercises. Children under five or six are not ideal candidates for formal facial reanimation surgery. As a child grows, the blood vessels become larger, increasing the likelihood of successful muscle transfers. Therefore, the earliest age for facial reanimation surgery is typically around five or six years of age.

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Congenital unilateral lower lip palsy

One specific condition related to congenital facial paralysis is “Congenital Unilateral Lower Lip Palsy,” or (CULLP). This condition occurs when patients have an asymmetric smile, where the corners of their mouth rise nicely but cannot reveal the bottom teeth on one side while smiling. Treatment for CULLP is relatively straightforward and may involve weakening the overactive muscle on the opposite side to restore balance and improve the smile’s appearance. In some cases, a small office-based injection is performed to ensure the desired effect before removing the overactive muscle in the opposite lower lip. Emerging techniques to restore movement to the opposite lower lip are on the horizon and hold promise for further improvements in treatment options.

Treatment options for congenital facial paralysis:

  • Pharmacologic weakening of the healthy side (BOTOX): BOTOX injections can temporarily weaken overactive facial muscles, restoring balance.
  • Office-based weakening of the healthy side (DLI Excision): This surgical procedure permanently weakens the overactive side.
  • Dynamic lower lip reanimation with cross-face nerve graft and muscle transfer: Surgical techniques involving nerve grafts and muscle transfers can help restore dynamic movement to the lower lip.

Congenital facial paralysis presents unique challenges, but with the proper treatment and intervention, individuals can achieve improved facial function and appearance, offering hope for a brighter future.

Why choose us?

In treating congenital facial paralysis, choosing the right specialist makes all the difference. Dr. Tessa Hadlock, a world-renowned expert in facial paralysis surgery in Boston, leads the Hadlock Center for Facial Plastic Surgery. With a wealth of experience and innovative techniques, she tailors treatment plans to restore facial function and appearance. Dr. Hadlock's expertise ensures that each individual receives unparalleled care, empowering them to regain confidence and live life to the fullest. Trust in us for comprehensive, cutting-edge solutions in the field of congenital facial paralysis.

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