The pediatric craniofacial specialists at the North Carolina Cleft and Craniofacial Center operate as a coordinated team to provide comprehensive care for children with facial paralysis, also known as facial palsy, and other craniofacial differences. The loss of facial movement in children is rare and can have many causes. Our board-certified medical professionals use the latest research and technology to guide diagnosis and treatment. Restoring facial movement requires a coordinated approach. Our team—including surgeons, ophthalmologists, and occupational therapists—collaborate to provide the best possible care for your child and are here for you from initial consultation through treatment and aftercare.

Facial paralysis in children can be present at birth or result from trauma and is often associated with other conditions, including Bell’s palsy and Moebius syndrome. It stems from damage to the nerve that controls facial movement and can affect one or both sides of the face.

Signs of facial palsy include:

  • Drooping of the face muscles
  • Uneven smile or facial expression
  • Problems with blinking and closing the eyes
  • Drooling
  • Difficulty with feeding, swallowing, and speaking


The diagnosis of facial palsy depends on the child’s health history, the duration and severity of symptoms, and whether one or both sides of the face is affected. The physician may use tests, including X-rays, MRI, or CT scans, to guide diagnosis. Early evaluation and treatment can improve outcomes and is especially important to help children develop socially.


Non-surgical therapies, including physical therapy, electrostimulation, and steroid of botulinum treatment (Botox), can help restore facial movement in some cases, depending on the cause and severity of the condition.

Surgery may be required to improve facial symmetry and movement in affected children.

Surgical options include:

  • Muscle or tendon transfers, in which a surgeon moves a muscle or tendon from its normal location to restore movement to a part of the face. For example, in one procedure, one end of a tendon connected to the jaw is moved closer to the mouth to restore the ability to smile. A segment of muscle from the leg can also be moved to the face to restore movement.
  • Nerve grafting, in which nerves from elsewhere in the body are moved to the face, can be used to improve movement and sensation.

If facial palsy affects a child’s eye, it can interfere with blinking, leading to dryness and eye disease. One procedure to restore blinking and complete eye closure uses a tiny weight attached to the eyelid. Surgeons may also use muscle or tendon transfers to improve eye closure and plastic surgery to lift the eyelid or eyebrow.


Following treatment for facial palsy, children receive supportive aftercare services, including close monitoring, occupational, speech, and physical therapy. Our experienced team of pediatric specialists collaborates to ensure that each child receives the best possible aftercare for the best possible outcome.