Birth Trauma

What does birth trauma mean in relation to facial palsy?

Birth trauma in relation to facial palsy refers to a physical injury to the facial nerve sustained during delivery of a baby.

What kind of birth trauma can cause facial palsy?

Facial palsy due to forceps

Forceps delivery: Forceps resemble large stainless steel salad servers and have curved ends called blades. When a baby needs help being delivered, forceps may be used to help the baby along the birth canal. Most babies delivered by forceps suffer no long-term problems, but in rare cases an injury is sustained to the facial nerve, due to the pressure of the forceps blade on the baby’s head. In many cases the injury is mild and temporary, and resolves within several months, but in other cases the facial paralysis can persist.

Pressure from a bone in the mother’s pelvis: Pressure can also be placed on the baby’s head by the pelvis for the following reasons:

• The baby’s head is presenting at a difficult angle.
• The mother’s pelvis is small.
• Large baby size.

If the baby experiences difficulty passing through the pelvis, then pressure may be placed on the facial nerve.

Other trauma: Any type of compression to the facial nerve during the delivery process can result in a facial weakness or full palsy.

What are the symptoms of facial palsy due to birth trauma?

The lower part of the facial nerve is most commonly affected in cases of facial palsy due to birth trauma. Symptoms may include:

• Mouth does not pull down on both sides when crying, known as ‘asymmetric crying facies’.
• The area below the eyes appears uneven when crying.
• The eyelid may not close fully or blink on the affected side.
• There is little or no movement on the affected side of the face.

Baby’s face bruised by forceps delivery

How is facial palsy diagnosed?

Facial palsy due to birth trauma is normally diagnosed by the health care provider while the infant is in hospital, although very mild cases involving just the lower lip may only be noticed later by the infant’s family. If you suspect facial paralysis and it has not been diagnosed, then you should make an appointment with your child’s health care provider.

A physical examination is carried out to diagnose facial palsy and if the reason for the facial palsy is unclear, then further tests may be carried out.

Are any medical tests carried out?

Further medical tests are not usually carried out at this stage unless the doctor wants to rule out other problems such as a tumour or stroke. See further information about medical tests.

What is the treatment for facial palsy in infants?

Because facial palsy due to birth trauma frequently improves on its own within a few months, there is often a ‘wait and see’ approach before further investigations are made. Infants diagnosed with facial palsy due to birth trauma are closely monitored to see if the paralysis goes away without further treatment. A team of specialists will follow the progress of the child; they will explain the various options available in the management and treatment of facial palsy, for example, possible future surgeries, physiotherapy, etc. Much will depend on the extent of the paralysis as to how much intervention is taken.