Trauma and tumors are responsible for significant morbidity in children and subsequent physical and emotional deficits may affect children for a lifetime. Trauma is the leading cause of death in children, and pediatric head and neck malignancies account for 12% of all pediatric cancer. It is not always possible to restore pre-injury structure and function, but collaboration between pediatric otolaryngologists, facial plastic reconstructive colleagues, and experienced physical therapists / speech language pathologists can help guide medical and surgical decision-making to provide the best outcome. This session provides an overview of the complexity and morbidity of cranial nerve deficits in children and encourage participants to engage experienced colleagues and institute multidisciplinary care for these difficult patients. Surgical management of skull base tumors and brainstem lesions can result in complete unilateral pharyngolaryngeal paralysis which carries significant morbidity and mortality. Multiple management options are available to the otolaryngologist, including laryngoplasty, thyroplasty, palatal adhesion, pharyngeal plication, and laryngeal reinnervation. We will discuss the advantages and disadvantages of these options in the setting of lower cranial nerve injury as well as the importance of early intervention with speech language pathology. Facial nerve injury from tumor or trauma can be devastating to a pediatric patient, yielding both physical deformity and important functional deficits, including those involving eye closure, nasal breathing, oral competence, speech, and facial expressions/nonverbal communication. Facial rehabilitation options are numerous; we will discuss treatment options and special considerations in pediatric patients. The functional and psychosocial impact of pediatric cranial nerve injury is extensive. This session activates conversation between subspecialties in otolaryngology and familiarizes us with the possibilities for reanimation, reinnervation, and restoration of structure and function.