What is included in the physical exam to evaluate congenital facial paralysis?

Updated: Jan 07, 2019
  • Author: Alan D Bruns, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Examine the infant bilaterally and evaluate both the upper and lower portions of the face. Looking at forehead wrinkling, eye closure, and lip movement. A bilateral facial palsy is frequently incomplete, affecting either the lower or upper portion of the face. This helps to distinguish developmental causes of congenital facial paralysis from traumatic causes that often involves the upper and lower face equally and are often unilateral.

A traumatic etiology often reveals a unilateral facial paralysis with ecchymosis, hemotympanum, facial swelling, and severe head molding. Documenting these findings during the immediate neonatal period assists in establishing an etiology. [31]

The examination needs to evaluate the other cranial nerves and rule out other congenital anomalies.

Often, a mild paresis of the facial nerve is not noticed at birth, especially if the injury is bilateral. When facial nerve paralysis is associated with hemifacial microsomia or other craniofacial abnormalities, the facial nerve is often not noted to be weak until the child grows and a more pronounced asymmetry develops, prompting closer evaluation of the facial nerve.

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