|IMAGES IN CLINICAL NEONATOLOGY
|Year : 2015 | Volume
| Issue : 3 | Page : 213-214
Traumatic facial nerve palsy in newborn: A benign condition
Deepak Sharma1, Srinivas Murki MD, DM Neonatology 1, Ginnavaram Dhanraj2
1 Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
2 Paramitha Children Hospital, Hyderabad, Telangana, India
|Date of Web Publication||2-Jul-2015|
Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
Facial nerve palsy in the neonatal period can be result of few reasons including congenital, trauma at the time of birth, or developmental. The majority of infants (more than 90%) with congenital facial palsy usually recover by 3-6 months. The most important step in management is eye care as these infants have incomplete eye closure. If the weakness persistent beyond 3 months than plastic surgeon should be brought in picture.
Keywords: Birth trauma, facial nerve palsy, newborn
|How to cite this article:|
Sharma D, Murki S, Dhanraj G. Traumatic facial nerve palsy in newborn: A benign condition. J Clin Neonatol 2015;4:213-4
| Introduction|| |
Facial nerve palsy in the newborn period is the results of many reasons including congenital, traumatic (instrumental delivery) or developmental, that result of developmental abnormalities of facial pathway (isolated or as part of syndromes like Mőbius syndrome). The congenital form is most common and carries the best prognosis of all causes. The majority of the infants (more than 90%) will have complete recovery with no reisdue; the process may take hours to 6 months. The majority, have been associated with instrumental deliveries especially forceps use. Pressure of the posterior blade that compresses the bone overlying the vertical segment of the facial canal is thought to be causative for it. The neonatal reisk factor includes large for gestational age baby size; prolonged labour; use of epidural anesthesia and use of a medication to cause labor and stronger contractions. 
| Case Report|| |
A term male neonate was born to primi mother with a birth weight of 3800 g and Apgar of 8/8/9 at 1 min, 5 min, and 10 min, respectively. Baby was delivered by forceps assisted vaginal delivery. At birth, the male infant was noted to have difficulty in closing the right eye, absence of forehead wrinkling, absence of nasolabial fold on the right side, asymmetry of the face especially on crying with deviation of angle of mouth to left side, impaired eye closure, and complete absence of facial movements on affected right side [Figure 1], [Figure 2] and [Figure 3]. Baby had difficulty in feeding because of the impairment of sucking. Infant was diagnosed to have lower motor neuron type of facial palsy. Infant was managed with artificial tears; eye padding and palsy gradually improved in follow-up. Differential diagnosis includes:
|Figure 1: Right facial nerve palsy of the newborn. Note the baby is not able to close the eyelid while crying|
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|Figure 2: Right facial nerve palsy of the newborn. Note the baby is not able to close the eyelid while crying. Also note deviation of the mouth toward the left side|
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|Figure 3: Right facial nerve palsy of the newborn. Note the baby is not able to close the eyelid while crying. Also note deviation of the mouth toward the left side|
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- Congenital facial nerve palsy
- Mobius syndrome
- Intracranial hemorrhage
- Congenital absence of facial muscles or nerve branches
- Cayler Cardiac syndrome (Absence of depressor angular oris).
Diagnosis of lower motor facial palsy as in this newborn is by physical examination and careful analysis of delivery history like history of prolonged labor, forceps delivery, periauricular or facial ecchymosis, or hemotympanum.  Mostly, traumatic lower motor facial nerve palsy in a newborn is self a resolving condition. Dryness of the affected eye is prevented by artificial tears and eye padding. If there is no improvement by 3 months of age, then electromyography (EMG) should be done. In infants who have a clinically complete facial nerve palsy, needle EMG may show some potentials on stimulation of nerve which tells that the nerve is still in continuity and have the potential for regrowth. Motor nerve conduction study (NCS) (motor NCS or electroneurography or evoked EMG) is done for prognostication.  This test involves stimulation of the main branch of the facial nerve near the stylomastoid foramen and recording the compound muscle action potential in millivolts. In the case of permanent facial nerve palsy, definitive treatment involves muscle and nerve transplantation. 
- Congenital facial nerve paralysis should be differentiated from traumatic facial nerve paralysis as early as possible as this determines the course of the disease process and treatment plan
- Careful physical examination and detailed birth history help in finding out the cause of traumatic facial paralysis
- Parents must be explained about this benign self-limiting condition, and adequate ophthalmic care should be given to neonate.
| References|| |
Shapiro NL, Cunningham MJ, Parikh SR, Eavey RD, Cheney ML. Congenital unilateral facial paralysis. Pediatrics 1996;97:261-4.
Valls-Solé J. Electrodiagnostic studies of the facial nerve in peripheral facial palsy and hemifacial spasm. Muscle Nerve 2007;36:14-20.
Alam D. Rehabilitation of long-standing facial nerve paralysis with percutaneous suture-based slings. Arch Facial Plast Surg 2007;9:205-9.
[Figure 1], [Figure 2], [Figure 3]