What is Facial Reanimation?
Facial reanimation is a treatment for facial paralysis. Children with facial paralysis have a muscle or muscles in the face that do not work the right way. This can affect how a child talks, eats, closes and opens their eyes, and uses facial expressions to show emotion. What often bothers kids is when facial paralysis causes their smile to be uneven.
Facial reanimation is a surgery that helps bring movement back to the paralyzed area of the face by transferring a muscle. In this surgery, a surgeon moves healthy muscle from the child’s leg to the paralyzed side of the face. The goal of the surgery is to improve a child’s ability to move the lower half of the face.
The surgery we perform at Cincinnati Children’s is a free functional gracilis muscle transfer. It is often called smile surgery, as it can bring back a child’s ability to smile.
Children must be at least 10 years old for this surgery. This is due to the very small size of the artery and veins to the muscle being moved.
Before Facial Reanimation Surgery
Your child will be put to sleep (have anesthesia) before surgery.
During Facial Reanimation Surgery
A plastic surgeon performs this surgery. At Cincinnati Children’s, we have two plastic surgeons who perform the muscle transfer together in order to get the best outcomes. One surgical team operates on the face while the other prepares the muscle in the leg for transfer.
The surgeons start by removing a small portion of the gracilis muscle from your child’s leg. This is a small muscle in the inner thigh. They also remove the muscle’s blood vessels and nerves. Removing this muscle and tissue will not affect how your child can walk. Your child will have a small scar along the upper part of the inner thigh, which is easy to hide.
In the second part of this surgery, the surgeons move the muscle into the side of the face. They attach the gracilis muscle’s blood vessels and nerves to blood vessels and nerves in the face so the muscle can survive in its new position. This involves sewing very small tissues together under a microscope. Surgeons can use a nerve from the normal side of the face (cross-face nerve graft) connected in an earlier surgery or a nerve to the adjoining muscle (masseter) in the same surgery. When they are finished, the surgeons close the incision in the face, and the surgery is complete. The scar on the face is hidden near the ear and is generally not noticeable.This is a complex surgery. It takes about six to eight hours to perform.
After Facial Reanimation Surgery
After surgery, your child will spend about four days in the intensive care unit. This is so the doctors can watch the blood vessels that were involved in the surgery and make sure they’re open.
Most kids return to school within two weeks after surgery.
Your child cannot play sports for about two to three months after surgery. Once healing is complete, typically two months after surgery, they can get back to their normal activities.
As the repair heals, the new muscle in the face will regain function slowly. Your child will start to have movement in the face over time. It can take anywhere from 4-6 months to begin seeing results after surgery. They will first notice the new muscle start to twitch. They may be taught to do facial movement exercises at this time.
If the masseter nerve was used, in order to make the new muscle work, your child will need to bite down to smile. Kids learn this rather quickly and it becomes fairly automatic for them.
Your child will return for regular check-ups after surgery as they heal.
Long-term Outlook
Kids with muscle transfer surgery usually go on to live normal, healthy lives. It is not possible to achieve perfect symmetry in the smile, but the changes are so significant that kids are very happy with the results.
Once the muscle is in place and working well, follow up is scheduled as needed.
Depending on the extent of their paralysis, children may have additional plastic surgery later in life (such as a brow lift or eyelid procedure).
