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Treatments and Procedures: Facial Paralysis Treatment for Children

Children occasionally may be born with complete, or more commonly partial, facial paralysis as a fetal anomaly. In addition, head trauma, birth injuries, Bell’s palsy and other conditions can cause facial paralysis in children, affecting their ability to speak, blink, eat or express emotions through facial expressions. A number of nonsurgical treatments can be effective; however, if the condition persists, surgical procedures can help restore form and function to the facial muscles.

Facial Paralysis in Children: Why Choose Johns Hopkins Facial Plastic Surgery?

  • With the large number of patients we see and the experience of our faculty, we offer a rare degree of skill and expertise even in the most complex procedures.
  • Surgeons Patrick Byrne, M.D., M.B.A., and Kofi Boahene, M.D., have unique skills in surgical reanimation techniques that can address paralysis of the face, including nerve and tendon transfers, microvascular surgery and oculoplastics.
  • Our staff and environment provide our patients’ families with clear communication and compassionate support throughout treatment.
  • We are dedicated to restoring children’s health and confidence, helping them recover from facial paralysis and regain both form and function.

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Sam’s Story: Facial Reanimation Surgery to Correct Facial Paralysis


Born with Moebius syndrome that left him with a crooked smile, Sam, a high school student, and his mother traveled from Syracuse, New York, to seek facial reanimation surgery from Johns Hopkins facial plastic and reconstructive surgeon Patrick Byrne.

Facial Paralysis Treatment for Children: What to Expect

Our experts will take a detailed history of your child’s facial paralysis, and may use video analysis to better assess the range of motion. Imaging studies such as X-rays, MRI or computed tomography scans of the child’s head can help identify any underlying issues.

Depending on the cause and severity of your child’s facial paralysis, Boahene and Byrne may be able to resolve the problem through nonsurgical therapies such as physical therapy, botulinum or steroid medication. A speech pathologist may be part of the child’s care team.

For severe or persistent facial paralysis in children, specialized surgical procedures can include:

Muscle transfers: The surgeon removes one or more tendon or muscle and relocates them to areas of the face where they can restore more natural movement. These procedures include:

  • Temporalis tendon transfer (T3) relocates one end of the temporalis tendon connected to the jaw and moves it closer to the mouth, which allows the child to smile by clenching the jaw. The T3 procedure takes about an hour and may be performed in an outpatient setting.
  • Digastric tendon transfer relocates a tendon connected to a muscle located under the jaw. 
  • Gracilis transfer relocates fibers from a slender muscle located on the inside of the leg. This surgery may require more than one procedure and several months of recovery, but enables a more natural-looking smile response that involves the entire face. 

Nerve grafting involves moving nerves from different parts of the body to the face. Grafting can restore both movement and sensation, increasing muscle control. Some examples of this technique involve moving the hypoglossal nerve in the tongue, facial grafting and cross-facial grafting.

Protecting the Child’s Eyes

Facial paralysis can affect a child’s ability to blink, resulting in dryness and potential damage to the eye. One treatment your doctor may recommend is the insertion of a tiny platinum weight in the upper eyelid, which enables the child to blink and lubricate the eye with natural tears.

In addition to addressing the paralysis itself, the surgeon may suggest other facial plastic surgical procedures such as lifting the eyelid or the brow, which can help restore the child’s visual field, function and appearance

Patrick Byrne and Kofi Boahene

Our Physicians

Meet Drs. Kofi Boahene and Patrick Byrne

Our doctors are board certified in both otolaryngology—head and neck surgery and facial plastic and reconstructive surgery, which gives our team a unique and comprehensive level of expertise.

Meet Dr. Byrne Meet Dr. Boahene

Different Surgeries, Same Result

Hear from patients who have had temporalis tendon transfer (T3) and gracilis free flap, two surgical techniques used for long-standing facial paralysis.

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