Here is the first in a series of Q & A answered by Mr Adel Fattah, Consultant Paediatric Plastic and Microsurgeon at Alder Hey Hospital.

There are many kinds of surgery to address different problems associated with facial palsy but facial reanimation refers to surgery that gives movement to the face. Specifically, this is primarily aimed at recreating the smile. To create movement in the face, one requires a nerve as an electrical supply and a muscle to perform the movement. This means that theoretically any combination of nerve and muscle can create movements in the face, but in practical terms two main options are available. The first is a local muscle transfer: this means moving a nearby muscle that is functioning normally into a position that can recreate a smile. The Temporalis and Masseter (chewing) muscles are the most commonly used, and the newest procedure the “Labbé Temporalis Myoplasty” is an example of this (detailed below). The other option is a free flap; also known as a free muscle transfer or muscle transplant. Whatever the technique, all are limited by the fact that a single muscle is used to pull in one direction that best mimics the natural facial muscles that are small and can pull in a multitude of different ways to create subtle facial expression. The techniques above are unable to create such subtle movements but are able to create a smile that will be relatively symmetrical to the other side.

About Adel Fattah

Adel is a consultant at the Alder Hey Children’s NHS Foundation Trust whose primary specialty is facial palsy reconstruction. He trained at Great Ormond Street Hospital and the Hospital for Sick Children, Toronto with Dr Ron Zuker. He has established a multidisciplinary team that provides holistic care for all aspects of facial palsy in children.