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Plastic and Reconstructive Surgery

Facial Paralysis Program


Reanimation of the paralyzed face

The Facial Paralysis Program at SickKids provides state of the art microsurgical reconstruction to animate the paralyzed face.  This will improve eyelid closure, oral continence, speech, facial symmetry and restore an even, beautiful smile.  Facial paralysis in children may be congenital, meaning present at birth, or it may be acquired from head and facial injuries or a consequence of brain tumours and complex surgery.  It may be one-sided (unilateral) as in developmental facial palsy, or involve both sides (bilateral) as in Moebius Syndrome.  Whatever the cause, the SickKids team is ready to help, has unparalleled expertise, and is in the forefront of advanced clinical care and innovation for this condition. Our Facial Paralysis Clinic is staffed by Dr. Greg Borschel and Dr. Ron Zuker, who are experienced pediatric plastic and reconstructive surgeons and microsurgeons.  They use nerve transfers, nerve grafts, muscle transplants and innovative reanimation techniques to achieve the desired result.

Our coordinator, Elizabeth Greczylo, facilitates appointments. We also have a specialist occupational therapist to help our patients maximize the benefits of surgery.  Our clinics are held monthly and involve this multidisciplinary approach.

Evolution of the Facial Paralysis Program at SickKids                      

The Facial Paralysis Program at SickKids began as microsurgical techniques could be applied to this most difficult problem. Before microsurgery, static procedures were used to position the drooping and asymmetrical tissues.  However, with microsurgery, muscles could be reinnervated or muscle could be transplanted to provide movement and animation.  This type of surgery began in the 1970’s and continues to evolve to the present day.  In the early years Dr. Ron Zuker and his colleague Dr. Ralph Manktelow used these techniques for unilateral facial paralysis.  They utilized small branches of the normal facial nerve to power the facial musculature of the opposite side via nerve grafts.  Where the muscles on the paralyzed side could not be innervated, new muscle was transplanted and powered by these cross-face nerve grafts.  In the 1980’s, it began apparent that there was a need to address the problems of bilateral facial paralysis.  Dr. Zuker and Dr. Manktelow worked in the anatomy lab and devised an operation whereby transplanted muscle would be powered by a different motor nerve – the motor nerve to masseter.  In addition to the innovative concept of innervating muscle, new techniques evolved to secure the muscle in its proper position and to reduce the amount of bulk, so that a symmetrical face with spontaneous and symmetrical movement could be achieved.  The techniques used continue to be modified.  

A Facial Paralysis Program continues under the leadership of Dr. Greg Borschel and Dr. Ron Zuker, utilizing nerve transfers, nerve grafts, and muscle transplantation.  New techniques are evolving for eyelid function restoration as well as the creation of a spontaneous and symmetrical smile.  Our unique program is open to all patients with facial paralysis, whether it be congenital or present at birth, or acquired from trauma or disease.  Our clinics are held monthly, with both surgeons present, and a specialist occupational therapist.  Together we will formulate a personalized plan that will meet the needs of the child with facial paralysis.