Authors of section


Damir Matic, John Yoo

General Editors

Daniel Buchbinder

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Irreversible paralysis - Midface and mouth

Midface and mouth

The consequences of midface paralysis are:

  • Nasal airway obstruction (external and internal nasal valve collapse)
  • Asymmetric smile
  • Loss of oral competence
  • Speech difficulty

Facial paralysis

Facial paralysis management needs to be considered based on location and degree of functional loss. Facial paralysis may involve the entire face, a portion, or any combination (e.g. brow, upper eyelid, lower eyelid, midface, lower lip). Paralysis can be either complete or partial loss of function and it can be reversible or irreversible based on the cause of nerve/muscle injury.

Definition of irreversible paralysis

Paralysis can be considered irreversible if:

  • Present for longer than 2 years
  • The distal nerve/motor unit is not present
  • Congenital facial paralysis (e.g. Moebius Syndrome)
  • No proximal or distal ending of facial nerve available


Imaging such as CT or MRI may be necessary in situations where the diagnosis or anatomy is uncertain. More details can be found in additional material, under the patient evaluation and management section.

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