Childbirth has many potential complications, especially in the case of medical negligence. One common birth injury that could leave lasting effects on a child’s life is facial paralysis. Facial paralysis is also often referred to as facial nerve palsy, as it is a type of nerve paralysis. This has long term functional and aesthetic complications if not addressed early on.
What is Facial Nerve Palsy?
Facial nerve palsy, also known as facial paralysis and Bell’s palsy, has many implications in its potential outcome. If not treated properly, children can be left with significant functional and aesthetic complications. Essentially, facial palsy is a type of condition that leads to weakness or paralysis in the face on either one or both sides. It occurs because of damage done to the seventh cranial nerve. The facial nerve is responsible for sensory and motor components and emerges from the hindbrain. This loss of voluntary muscle movement and sensation has many causes during childbirth1.
Causes of Facial Paralysis in Childbirth
Both medical negligence and natural causes can lead to facial palsy. In terms of natural causes, if the birthweight of the baby was high, such that the baby was large, the baby might have suffered squeezing through the birth canal. This squeezing sensation puts pressure on the area of the seventh cranial nerve which compresses it and restricts its activity. A similar cause of facial nerve palsy is prolonged labor. This leads to extended pressure put on the face of the baby as it travels through the birth canal.
Another less common cause of facial paralysis is the incorrect distribution of an epidural. An epidural is a type of regional anesthetic injection that helps block pain in a particular spot in the body. This reduces childbirth pain for the mother. However, when administered incorrectly or the mother is not closely watched, the baby could sustain excess facial pressure due to body positioning2.
Next, Pitocin is a commonly distributed medication during childbirth. It mimics oxytocin, which is a hormone that stimulates contractions in delivery. If the improper Pitocin dosage is administered, the mother could have too strong or too weak of contractions. Both of these conditions can lead to facial paralysis if not observed throughout the entire delivery.
The final and most common causes of facial paralysis in newborns is due to the use of forceps and vacuums during an assisted delivery. In the case of prolonged labor where dilation is not occurring as rapidly as needed, physicians may assist delivery by guiding the baby out of the birth canal using tools. First, forceps are spoon-shaped tongs that are used to grasp the sides of the baby’s head in the canal. The physician is supposed to gently hold the forceps and help guide the baby out of the canal. However, if the forceps are held too firmly or placed improperly, such as on the front and back of the face of the baby rather than the sides of the head, facial nerve paralysis is possible1.
With vacuum assisted delivery, the process is similar but rather a plastic suction cup is attached to the top of the baby’s head rather than the use of tong-like forceps on the sides. The vacuum generates suction force and prevents the baby from moving up the birth canal, rather than down, between contractions. If the vacuum cup is misapplied to the head, such that it attaches to a part of the face, facial palsy could occur1.
Symptoms of Facial Paralysis in Newborns
There are many potential symptoms of facial paralysis depending on the severity of the case. In newborns, facial paralysis is most recognized by observing the face. It could potentially look frozen in place, even when crying. This may look like one side of the face is drooping and often caused by muscle weakness. Without nerve innervation actively happening, the muscles are not stimulated and therefore droop.
Similarly, the newborn might display an asymmetrical smile or an inability to blink. This further points to facial nerve palsy, as the ability to move is not being coordinated due to damage of the nerve pathways of the face. This is correlated with excessive drooling and difficulty feeding since the lower face might not be able to close or latch on to a nipple successfully.
Prognosis of Facial Paralysis
Depending on the severity of the facial palsy case in a newborn, prognosis ranges from temporary to permanent paralysis. In mild cases, facial nerve paralysis can go away on its own within a few months. However, more severe cases may require physical therapy, botulinum injections, or steroid medications. A final treatment for pediatric facial paralysis is surgical therapy to relocate muscles and tendons to different areas of the face where they can move more naturally3.
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