II. Pathophysiology

III. Etiology

  1. No Traumatic cause in most cases
  2. Postulated causes (Birth Trauma)
    1. Forceps blade Trauma
    2. Molding
  3. Congenital Facial Palsy
    1. Mobius syndrome
    2. Cardiofacial syndrome

IV. Signs

  1. Central Facial Nerve Injury
    1. Asymmetrical face with crying
    2. Forehead and Eyelid not affected
    3. Abnormal side
      1. Skin on abnormal side is smooth and swollen
      2. Nasolabial fold absent
      3. Corner of mouth droops
      4. Weakness Depressor Anguli Oris with drooping corner of mouth (e.g. especially while crying)
    4. Normal side
      1. Mouth deviated to normal side
      2. Wrinkles deeper
  2. Peripheral Facial Nerve Injury
    1. Asymmetrical face with crying
  3. Peripheral Facial Nerve branch injury
    1. Asymmetrical face with crying
    2. Affects only forehead, eye, and mouth

V. Differential Diagnosis

  1. Nuclear agenesis (Mobius syndrome)
  2. Congenital absence of facial muscles
  3. Orbicularis Oris muscle absent on one side
  4. Intracranial Hemorrhage

VI. Management

  1. Eye Protection
    1. Eye patch
    2. Methylcellulose drops (artificial tears) q4 hours
  2. Neurology for Electrodiagnostics Indication
    1. Lack of improvement by 7 to 10 days of life

VII. Course

  1. Recovery begins by first week of life
  2. Resolution anticipated over several months
  3. Traumatic palsy usually resolves completely
  4. Persistent palsy may suggest nerve absence

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