Sometimes people are born with weakness on one or both sides of the face. The weakness might involve all of the divisions of the face, or only the upper, central, or lower part of the face. Congenital bilateral facial paralysis is usually referred to as Mobius syndrome. Facial weakness at birth can be related to a genetic mutation, or as part of a syndrome, or it can be related to in-utero or birth trauma. The only way to distinguish between a genetic problem or syndrome, and trauma, is to observe for signs of recovery. Usually birth trauma and in-utero positioning problems will result in some degree of recovery, even though recovery might not be perfect. In the modern age, birth trauma and in-utero insults are much less likely than simple genetic mutations or syndromes, and they are not highly suspected when patients are born with facial weakness. Every condition of congenital facial paralysis is managed a little bit differently. Quite often, patients do beautifully from a developmental standpoint, and do not require any intervention at all until they become school-age and they get interested in trying to achieve more facial balance or have a more meaningful smile. Interestingly, children who are not able to close their eye well even from birth, are able to adapt much more easily than adults who lose facial function. There are many options for children with congenital facial paralysis, ranging from simple injections to weaken the overactive healthy side of the face, all the way through surgery to restore dynamic smile. Physical therapy also plays an important role in optimizing function for children, and by around the age of four, children are able to be fully cooperative with this type of exercise. Most centers would agree that children below the age of five or six are not as good candidates as patients over that age, for formal facial reanimation, because as children grow their vessels get larger and the likelihood of successful muscle transfers becomes higher. For that reason, the earliest we typically perform facial reanimation surgeries is age 5-6.
Syndromes that commonly are associated with facial weakness include Goldenhar’s Syndrome/hemifacial microsomia, CHARGE Association, and VACTREL syndrome.