Facial Nerve Palsy and Birth Trauma

Occasionally, babies are born with facial nerve palsy (or paralysis), which involves the loss of controlled movement in facial muscles (1). This can be due to either a traumatic birth injury or a developmental deformity (e.g. genetic condition) involving the brain or facial nerve. In about 88% of cases, it is due to trauma (2).

When facial nerve palsy is due to traumatic injury, it is most often associated with forceps deliveries, especially with the use of middle forceps as opposed to low forceps (2).

There are several other factors that can increase the risk of damage to the facial nerve and other types of birth trauma (such as permanent brain injury). These include the following (1, 2, 3):

• Macrosomia (a large baby; this is often due to gestational diabetes)
• Cephalopelvic disproportion (when the baby’s head cannot fit safely through the mother’s pelvis, either because the head is unusually large or the maternal pelvis is unusually small/malformed)
• Abnormal fetal presentation
• Postterm pregnancy
• Prolonged labor and delivery
• Use of epidural anesthesia
• Use of a medication to induce labor/enhance contractions (such as Pitocin or Cytotec)
• Primiparity (it is the mother’s first time giving birth)

Facial nerve palsy most often involves only the lower part of the facial nerve, which affects the muscles around the lips. This type of palsy will be most noticeable when the infant cries, and the mouth does not move down symmetrically on both sides (1).

The following are some additional signs of facial nerve palsy in a newborn (1, 2):

• Eyelid doesn’t close completely
• No movement on one side of the face (in severe cases, this may involve everything from the forehead to the chin)
• Difficulty nursing

In most cases, facial nerve palsy resolves on its own. However, if results in permanent palsy/paralysis, the child may experience additional complications. These include (2):

• Speech problems
• Unusual expressions of emotion
• Difficulty with chewing
• Physical deformities

Typically, facial nerve palsy is diagnosed by a healthcare provider before the infant leaves the hospital. However, in very mild cases, it may be noticed for the first time after discharge, by the infant’s family. If parents suspect that an infant may have facial palsy, they should make an appointment with a doctor (3).

Facial nerve palsy can usually be diagnosed via physical examination. In some cases, doctors will also perform a nerve conduction test in order to determine the cause of nerve damage (1).

The severity of palsy/paralysis can be graded using a variety of different systems. The House-Brackmann Scale is the most widely used, although its interrater reliability is only “fair” (2). To learn more about the House-Brackmann Scale, click here.

Generally, facial nerve palsy in a newborn is closely monitored to see whether it goes away on its own (which it often will). However, depending on the extent and permanence of the paralysis, a variety of interventions may be warranted. These include the following (1, 2):

• Eye protection (eyedrops, ointment, and a patch) and frequent opthamologic evaluations for corneal abrasions and other issues
• Surgery to relieve pressure on the nerve
• Surgery to correct aesthetic concerns (some professionals recommend doing this early in a child’s life in order to avoid psychosocial problems, while others advise waiting until adolescence, when facial growth is mature and the child is more able to understand the risks and benefits of surgery)
• Physical therapy
• Speech therapy

Medical professionals can often prevent facial nerve palsy and other forms of birth trauma by carefully monitoring patients’ pregnancies, and intervening as necessary. If doctors use birth assisting tools such as forceps, or a labor-enhancing drug such as Pitocin, it is critical that they do so as indicated.

If your child or loved one has been permanently harmed by facial nerve palsy, brain damage, or another type of birth trauma, the medical malpractice attorneys at ABC Law Centers: Birth Injury Lawyers may be able to help. We exclusively handle birth trauma and birth injury cases, so we have the legal and medical expertise necessary to advocate successfully for our clients.

1. Facial nerve palsy due to birth trauma: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved October 26, 2018, from https://medlineplus.gov/ency/article/001425.htm
2. Congenital Facial Paralysis. (2018, July 26). Retrieved October 26, 2018, https://emedicine.medscape.com/article/878464-overview
3. Birth Trauma. (n.d.). Retrieved October 26, 2018, from https://www.facialpalsy.org.uk/causesanddiagnoses/birth-trauma/