Facial paralysis is a serious type of birth injury that prevents muscles in the face from moving. While there are several types of facial paralysis, including Möbius syndrome, the most common is Bell's palsy. The severity of facial paralysis, however, increases when it happens congenitally, or when it is present at the time of birth. This is because the repercussions are far more severe when facial paralysis happens congenitally: It can prevent a newborn from nursing or even closing its eyes, and these problems can lead to further health conditions at a crucial time in a newborn child's development.
Congenital Facial Paralysis Statistics
For every 1,000 births, newborns have facial paralysis in between 0.8 to 2.1 of them. Out of those that do have the condition at birth, nearly nine out of ten are associated with a difficult labor. A delivery that uses a forceps tool is a major contributor to this number because of the trauma that it inflicts on the newborn during the delivery process.
To complicate things, there is a whole spectrum of facial paralysis in newborns, ranging from slight muscle weaknesses to the complete facial paralysis that is Möbius syndrome. Newborns are rarely born with Möbius syndrome – out of a million births, only between 2 and 20 are born with the condition – but the severity of the facial paralysis is acute. The chances of being born with a minor paralysis are far higher.
Causes of Congenital Facial Paralysis
Facial paralysis in newborns often comes from either a traumatic or difficult birth, or a developmental deformity in the fetus dealing with either the brain or the facial nerve, also known as cranial nerve VII. This nerve starts in the brain, leaves the skull at the brainstem through the facial canal, and then branches out into the face to control the muscles in the cheeks, forehead, eyes, nose, and mouth.
Facial paralysis deformities that are the result of a traumatic birth are far more common than those that happen because of a developmental problem. Large babies, especially those that weigh over 7.75 pounds, face an increased risk of being born with facial paralysis because the facial nerve can get squeezed during delivery at the point where it leaves the skull and enters the brainstem. This trauma can lead to a temporary loss of function in cranial nerve VII or, in extreme and rare cases, cause a complete break in the nerve.
When doctors have to help a mother deliver their newborn child, they often use a forceps tool to help the baby escape. However, if they use the forceps poorly, they can cause congenital facial paralysis by pinching its posterior blade against the bone that covers the facial canal. This is the same canal that houses cranial nerve VII as it leaves the brain and goes reaches to the facial muscles, so pinching and damaging the canal can also have serious repercussions for the nerve, as well.
In addition to a traumatic birth, developmental issues can also cause congenital facial paralysis. While these are rare when compared to traumatic causes of facial paralysis in newborns, there are numerous different developmental problems that can underlie a baby's inability to move their facial muscles. These include:
- Möbius syndrome, which includes a complete facial paralysis that prevents a newborn from forming facial expressions, closing their eyes, or even moving their eyes from side to side. The syndrome results from underdeveloped cranial nerves VI and VII, but its causes are still uncertain.
- Facial dysplasia, which prevents a portion of the face from fully developing. This is caused by an insufficient blood supply to the face during a fetus' development and can cause a significant amount of facial paralysis, as well.
- Teratogens, or drugs that cause birth defects, can be at the heart of a newborn's paralyzed facial muscles. Two teratogens that have been linked to congenital facial paralysis have been thalidomide, a sedative used to treat certain kinds of cancer, leprosy, and multiple myeloma, and the drug misoprostol, which is used to prevent and treat lesions in the gastrointestinal tract.
How Doctors Can Prevent Facial Paralysis
One of the easiest ways that doctors and medical professionals in the delivery room can prevent a case of congenital facial paralysis from occurring or worsening is simply to use proper delivery techniques if a birth becomes difficult. Studies have shown that there is more instances of facial paralysis in newborns who were delivered using the “middle forceps” technique, rather than the “low forceps” technique. While the difference between the two is a matter of centimeters, “middle forceps” requires the doctor to pull a newborn further through the birth canal, increasing the risk of facial paralysis.
Another way that doctors can prevent facial paralysis from happening is by closely monitoring the prescriptions that you are being given. Because some kinds of drugs can trigger developmental issues that can lead to damage to the seventh cranial nerve, prescribing these drugs to a pregnant woman can lead to these kinds of congenital deformities.
Congenital Facial Paralysis Symptoms
Symptoms of a newborn's facial paralysis include:
- Facial movement on one side of the face that is different than on the other,
- Inability to completely close their eyes,
- Feeding difficulties as they struggle to control their mouth muscles, or
- Facial swelling immediately after birth, in the case of paralysis caused by trauma.
These symptoms can be difficult to detect if they affect both sides of the child's face or both the upper and lower halves.
Medical Malpractice Attorneys Can Help
Congenital facial paralysis can prevent a newborn from feeding or closing their eyes. This can lead to numerous other health issues down the road and can impact their eyesight as they are unable to protect or moisten their eye with their eyelid.
Instances like these are dangerous and, perhaps even more frustrating, often preventable. If a doctor or other medical professional caused your child to have facial paralysis or could have taken affirmative steps to prevent it from happening, it can amount to medical malpractice and you could get compensation for your child's well-being. Call the law office of the medical malpractice attorneys at Gilman & Bedigian at (800) 529-6162 or contact us online for a free consultation.