Congenital Facial Nerve Palsy

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

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
Peripheral Facial Nerve Injury
1. Asymmetrical face with crying
Peripheral Facial Nerve branch injury
1. Asymmetrical face with crying
2. Affects only forehead, eye, and mouth

Brainstem motor nuclei hypoplasia or agenesis (Mobius syndrome)
Arnold Chiari syndrome
Genetic malformation
1. Congenital absence of facial Muscles
2. Orbicularis Oris Muscle absent on one side
Neonatal stroke
1. May present with Neonatal Seizure, apnea, Hemiparesis or focal weakness
2. Incidence: 9.6 per 100,000 live births in U.S.
3. Types
  1. Ischemic CVA (arterial territory)
  2. Intracranial Hemorrhage
  3. Periventricular venous infarction

Eye Protection
1. Eye patch
2. Methylcellulose drops (artificial tears) q4 hours
Atypical presentations (or lack of improvement after first 2 weeks)
1. See differential diagnosis above
2. Consider pediatric neurology Consultation
3. Consider MRI Brain
4. Consider electrodiagnostics
Persistent facial palsy (esp. >2 months)
1. Physical therapy
2. Surgical interventions
  1. Lid loading surgery
  2. Microneurovascular Muscle transfer

Traumatic palsy resolves completely in most cases
1. Recovery begins by first week of life
2. Complete resolution anticipated over first 2 months of life
Persistent facial palsy (>2 months) causes
1. See Differential Diagnosis above