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Facial Paralysis from Birth
There are several causes of congenital (present at birth)
facial paralysis. They are genetic causes (predetermined in the genes),
paralysis related to in utero insult, and paralysis caused by trauma during
delivery.
It is important to make an effort to identify the cause of the paralysis,
since management differs according to etiology.
Certain genetically determined syndromes have facial paralysis as one
of their features. The most well known of these is called Mobiius Syndrome,
in which there is a congenital absence of the facial nerve and/or musculature
on both sides, as well as abducens nerve palsy. There is a bilateral facial
paralysis and inability to move the eye(s) out to the side, with no chance
of spontaneous recovery.
Goldenhar’s Syndrome refers to maldevelopment
of the first and second branchial arches, leading to hemifacial microsomia
and facial nerve abnormalities. Some evidence points to an early in utero
insult contributing to the development of hemifacial microsomia in some
cases.
When a newborn child appears to be completely normal, except a facial
palsy is present at birth, the possibility of birth trauma to the nerve
must be considered. Cases of facial nerve damage from skull base fractures,
from forceps delivery, and from shoulder dystocia have been reported.
In these situations, injuries are virtually always crush injuries rather
than transection injuries, and the prognosis for spontaneous recovery
is good.
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Example
of Congenital Facial Paralysis
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