Paresis of the facial nerve in newborns, neuritis of the facial nerve in children, damage during childbirth

In medicine, complications such as paresis of the facial nerve in a newborn are often encountered. As a result, the muscle tissue on the side where the lesion occurred is immobilized. The facial nerve passes through a narrow canal, so there is a high risk of compression.

Varieties

There are several types of facial nerve paresis in a newborn baby. The following forms of paresis can be distinguished:

central;
peripheral.

Peripheral lesion

Congenital peripheral paresis is common. The cause of this form is local compression of the nerve during childbirth. Another name for this form is Bell's palsy. Everything is manifested by an increase in muscle tone, the child’s face is asymmetrical, his mouth is distorted, the nasolabial fold is smoothed. Noteworthy in case of paralysis is lagophthalmos, the eyeball is directed upward when trying to close the eye.

The newborn is worried about pain in the area of nerve innervation, the ear, the back of the head, and the eye area. Saliva constantly flows from the corner of the mouth, the mucous membrane is constantly dry, and hearing is impaired. Parents should pay attention to the fact that the baby’s cry has changed, and a tear flows from the eye on the affected side. The eye may be dry due to drying out of the mucous membrane.

Central lesion

Symptoms of paresis of the facial nerve of the central type occur as a result of injuries when passing through the birth canal. Such conditions are accompanied by disruption of brain function and strokes.

The child notices a weakening of the tone of the facial muscles; on the affected side, the functioning of the muscles is impaired not only in the face, but also in the torso. Often the lesion is bilateral, but the symptoms do not extend to the upper part of the face or eyes. The taste is not affected. There is a condition called congenital paresis, which is caused by nerve abnormalities.

Facial nerve paresis in newborns: symptoms, surgery and treatment at home

This article talks about the symptoms of facial paresis in newborns. Describes the causes, diagnosis, treatment (including surgery), consequences, prognosis and prevention of the disease.

One of the possible complications of the birth process for a child may be facial nerve paresis . The facial nerve moves the facial muscles and is responsible for the first search reflexes (sucking). Damage during childbirth to this nerve is caused by its passage in a narrow canal, which increases the risk of paresis due to prolonged compression of the nerve fiber.

Facial nerve paresis is characterized by immobilization of the muscles on the affected side.

Types of facial nerve paresis

Facial nerve paresis is divided into:

Central paresis;
Peripheral paresis;
Congenital.

Peripheral paresis is a more common complication during childbirth due to local compression of the facial nerve itself. Peripheral paresis is also called Bell's palsy.

Manifests:

hypotonicity ;
asymmetry of the face (warping of the mouth, smoothing of the nasolabial fold);
lagophthalmos (the eyeball points upward when trying to close the eye);
pain in the area of innervation of the affected nerve, in the ear area, behind it, in the back of the head, in the eye;
leaking from the corner of the lips;
drying out of the oral mucosa;
impairment ;
disorder ;
lacrimation or lack of eye hydration on the side of the innervation of the affected nerve.

Central paresis occurs as a consequence of more dangerous birth injuries, accompanied by brain damage, stroke and manifests itself:

Weakening of the muscles of the lower part of the face;
Hemiparesis not only of the face, but also of the torso;
Both sides of the face often affected
The upper face and eyes retain their function and are not affected by symptoms;
No taste disturbances.

Congenital facial nerve palsy occurs when there is an abnormality of the facial nerve.

Severity

1st degree. It is manifested by a mild course, slight asymmetry of the face with intact closing of the eye (difficulty), frowning of the eyebrows, the corner of the mouth is lowered, the sucking process is disrupted;
2nd degree. Characterized by lagophthalmos. When performing functional diagnostic tests (smile, frown, close the eyes), the child does not complete them completely or does not perform them at all. These tests are carried out taking into account age, that is, the newborn does not yet understand human speech to complete the task, so they are carried out when the child is crying or sleeping and can spontaneously smile.
3rd degree. It manifests itself in a severe course. Symptoms increased. Severe facial asymmetry, eyes cannot close, diagnostic tests are positive (not performed), difficulty chewing and speaking (almost impossible).

Causes of facial nerve paresis

The most common reasons:

The main cause is neuritis (inflammation) of the facial nerve;
Compression of a branch of the facial nerve (birth injuries, childbirth using obstetric forceps, prolonged standing of the head in the pelvic cavity);
Infectious diseases of the mother during gestation;
Hypothermia of the newborn;
Viral and infectious diseases of the child after birth;
When performing surgery to eliminate another pathology;
Inflammation of the ear (otitis media). In acute otitis media, paresis occurs as a result of infection of the nerve trunk and is explained by the development of toxic neuritis with swelling of the loose connective tissue surrounding the nerve, and its subsequent compression in the bony canal of the facial nerve;
May occur with congenital syphilis;
May occur with multiple complications in case of mumps, polio after birth;
Tumors;
A certain role in the development of neuritis is also played by progressive osteitis of perifacial cells, vascular dyscirculatory disorders in this area, as well as dehiscence in the bone wall;
Central paresis of the facial nerve occurs with damage to the brain, strokes and other pathologies;
Congenital paresis occurs when there are abnormalities in fetal development;

Symptoms of facial paresis

Symptoms:

Muscle weakness (hypotonia) in the area of innervation of the facial nerve on one or both sides;
Pain in the ear area , behind the ear;
Tearing or drying of the mucous membrane of the eyeball;
Impaired maternal breastfeeding;
Leakage of milk from the mouth;
Increased sensitivity to loud sound;
Tearfulness;
The eyelids are open , lagophthalmos on the side of the nerve lesion.

Symptoms develop acutely over two weeks. The subacute phase lasts for a month. And the chronic phase is diagnosed when paresis remains untreated for more than a month.

Diagnosis of the disease

Diagnostic methods:

Objective studies are carried out (functional diagnostic tests: smiling, wrinkling the forehead, sucking, stretching the lips with a tube, carried out at rest or while screaming);
Consultation with other specialists to exclude pathologies and tumors of the face and ear;
Electromyoneurography to study the speed of nerve impulses;
CT scan;
Magnetic resonance imaging (to exclude brain damage);

Treatment of facial nerve paresis

Treatment of damage (paresis) of the facial nerve in a newborn is a gradual process.

Parents need to be patient and follow all the specialist’s recommendations:

Immediately after birth, the newborn is given special therapy.
It is also recommended to avoid noise and strong sounds (do not use rattles in games, do not talk loudly), and cover the sore side with a diaper during walks.
Treatment of concomitant diseases (if any);
Preparations to relieve swelling of affected tissues;
Vitamin therapy (B vitamins are prescribed);
Drugs that stimulate and improve blood circulation (dibazol, lidase, vazonit, sermion and others);
Corticosteroid drugs to quickly relieve swelling (prescribed for severe disease and with very careful administration and constant monitoring);
Symptomatic treatment:
Instillation into the eyes (artificial tears, antibacterial drops (floxal, tobrex, albucid and others) in case of dryness and impossibility of closing the eye);
Painkillers (ketamine, efferalgan, paracetamol, ibuprofen and others);
Local treatment:
Applications of paraffin , ozokerite;
Dry heat (for a newborn, it is enough to heat a soft cloth made from natural substances to body temperature or slightly higher (38 degrees) and apply it to the affected area during sleep, but always under supervision);
The use of ultrasound in the area of innervation of the affected nerve;
Physiotherapy:

Gymnastics should be carried out immediately after diagnosis; it is characterized by innate reflexes aimed at moving the facial muscles.
For example, when pressing fingers to a child’s lips, the lips are pulled into a tube, and a proboscis reflex occurs; when the skin of the cheek near the lips is touched, the baby begins to look for the chest with his lips, thereby causing motor activity of the muscles; when you press the center of the baby’s palm, he opens mouth.
Also a positive effect is the use of a pacifier.

It is carried out symmetrically on both sides of the face.
The massage should be performed by a specialist.
massage technique is to prevent atrophy of the facial muscles due to the temporary impossibility of their movement.
Begin the massage by kneading the neck muscles. At the same time, they tilt their heads in different directions.
All massaging movements are performed symmetrically and along the outflow of the lymphatic system, but the lymph nodes are not exposed to the massage area.
If the child begins to be capricious, this indicates pain in the pressure area. In this case, the massage should be carried out using light and superficial techniques.

Treatment at home

Treatment of facial nerve paresis at home is possible only after therapy and prescribed treatment by a specialist.

At home, they recommend:

learn light but regular massage techniques;
carry out daily therapeutic physical exercises;
give medications prescribed by a neurologist.

Severity of the condition

There are several degrees, which manifest themselves in their own special way.

The first degree is characterized by a mild course: slight asymmetry of the face appears, the child may have difficulty closing his eyes, and is able to frown. The corner of the mouth droops, the sucking process is disrupted.

One of the symptoms of the second degree is lagophthalmos; the child cannot perform special tests or does not perform them completely; it is difficult for him to frown, smile, or close his eyes. This kind of testing is carried out taking into account the age; the newborn does not understand human speech and is not able to fulfill the request of the elder. Diagnostic tests are carried out while crying or during sleep, when the child himself can smile.

The severity of the third degree is due to the complexity of the lesion. Symptoms intensify, significant facial asymmetry attracts attention, and the child is unable to close his eyes. There is no need to seize the moment to perform functional diagnostic tests; they will be positive at the first examination. “Speech” and sucking become difficult, almost impossible.

Diagnostics

We list the common methods:

Primary testing is for the ability to smile, wince, sucking function, use of lips in a calm state or during a cry.
Consultation with other doctors is carried out in order to exclude the development of neoplasms and various pathologies.
Electromyography allows you to determine the speed of passage of a nerve signal.
CT scan.
An MRI helps rule out possible brain damage.

Reasons for the development of the condition

A very common cause is neuritis or inflammation of the nerve. It can be compressed when passing through the birth canal or when obstetric forceps are applied incorrectly or when the head is in the pelvic plane for a long time. The cause may be infectious pathologies suffered during pregnancy, or hypothermia, which can cause not only inflammation, but also infections.

The cause may be surgery for another pathology. A very serious condition is otitis media or ear inflammation. The middle location of otitis is dangerous, in which inflammation of the facial nerve can occur. Infection in the tissue surrounding the nerve leads to its inflammation and swelling in the canal of the temporal bone in which it passes.

Another reason worth paying attention to is congenital syphilis. Also, paresis can be the result of mumps, because the nerve passes through the tissue of the parotid salivary gland and is divided into five branches. The cause may be polio immediately after birth. The cause of a central type lesion will only be a traumatic brain injury received during childbirth.

Symptoms of the condition

What is noteworthy in case of facial nerve paresis is increased or, conversely, decreased muscle tone in the area of innervation of the nerve on one side, but the process can be bilateral in nature. The child's ear or area around it hurts. Tears constantly flow, but the opposite can happen when the mucous membrane of the eye constantly dries out.

The sucking of milk from the breast is impaired, the baby eats reluctantly, food flows out through the corner of the mouth. Sensitivity to loud sounds increases, the child becomes whiny. The eyelids are wide open, and lagophthalmos is noticeable on the affected side.

The development of symptoms occurs acutely, within two weeks after the baby is born. The period for the development of the subacute phase is a month; if beyond this period the treatment has not brought a positive result, it is worth talking about a chronic disease.

The need for surgical intervention

The operation is indicated in the following cases:

nerve rupture;
paresis caused by trauma;
congenital facial paralysis;
ineffectiveness of conservative treatment for chronic disease.

In case of rupture, surgery involves suturing the damaged area of the facial nerve. This intervention is quick and rehabilitation does not require a long time.

For congenital paralysis or other anomalies, nerve transplantation from other parts of the patient’s body is used.

The operation leaves no visible scars, except for a small strip behind the ear. As a result of surgical intervention, the asymmetry is successfully corrected, and difficulties with facial expressions do not arise in the future.

Establishing diagnosis

There are several diagnostic methods for facial nerve paresis; in addition to examination, functional tests are performed. The doctor can perform them at rest or by inducing a cry. The doctor is interested in a smile, wrinkling of the forehead, whether breast sucking is impaired, or whether the lips are drawn out with a tube.

Consultation with related specialists is required to rule out ear pathology or oncology. The speed of impulse conduction is shown by electroneuromyography. A computed tomogram and MRI are performed to rule out pathology in the brain.

Physiotherapeutic methods

Along with drug treatment, physiotherapeutic methods are used. As a rule, electrophoresis or phototherapy is indicated for paresis. Low-frequency magnetic therapy methods are also used.

Physiotherapeutic methods are aimed at restoring normal blood flow. They help improve metabolic processes in the affected area and relieve spasm of nerve fibers.

In addition to physiotherapy, some massage techniques and acupuncture are used. All this allows you to improve local blood circulation and gradually helps restore the ability to control your own facial expressions.

Patients are shown facial gymnastics, which helps restore motor activity. It includes the following exercises:

“frowning eyebrows” - the patient needs to frown and relax the brow ridges several times a day;
“full cheeks” - you should puff out your cheeks as much as possible and then relax them;
“whistle” - you need to stretch your lips folded forward as much as possible, imitating a whistle.

Exercises for developing the facial muscles responsible for the movement of the eyelid also help: the eyes should be opened as wide as possible, making a surprised face, and then relax. Gymnastics is performed up to 10 times a day, in any free minute.

However, gymnastics or massage alone cannot cure paresis, so it is necessary to combine these methods with conservative drug treatment.

Treatment process

Facial nerve paresis can be overcome gradually, with a systematic approach to the treatment process. Parents must strictly follow the specialist’s recommendations, implementing them flawlessly. Immediately after birth and diagnosis, a special type of treatment is carried out. The child must be immediately protected from strong sounds and noise.

During the game, it is strictly contraindicated to use rattles or talk loudly. When walking, the sore side of the face should be covered with a diaper. It is imperative to undergo treatment for concomitant pathology, if any.

Medicines

It is recommended to use agents that relieve swelling from the affected nerve tissue. It is useful to use B vitamins to restore conductivity. Drugs are indicated to improve blood flow. To quickly combat swelling and inflammation, your doctor may prescribe corticosteroid hormones. The indication for their use is a severe course of the disease, when it is necessary to carefully manage a small patient and constantly monitor him.

Symptomatic treatment is mainly used: drops are instilled into the eyes, replacing tears, antibacterial, when it is impossible to close the eyes. Additionally, painkillers are prescribed.

Physiotherapy techniques

Physiotherapy is not actively used in a newborn. Applications of paraffin and ozokerite give an excellent effect. It is useful to use dry heat; for a child, you will need to heat the fabric to body temperature or no more than 38 degrees. The fabric must be natural, applied to the affected area while the child is sleeping, the procedure is carried out only under the supervision of the parents. The use of ultrasound is indicated at the site of the lesion.

Gymnastics

Gymnastics are carried out immediately after the correct diagnosis is made; it is aimed at restoring innate reflexes and movements in the facial muscles. For example, pressing a finger to the lips leads to their pulling into a tube, this is called the proboscis reflex. Touching the skin of the cheek near the lips leads to the fact that the child tries to look for the mother's breast, this promotes motor activity of the muscles. Pressing the center of the palm causes the child to open his mouth. Using a pacifier has a positive effect on the overall well-being of the child.

Massage

This technique gives a positive result after its application, because facial massage helps restore normal nerve conduction. The goal of the massage technique is to prevent muscle atrophy when they temporarily lose their function.

The procedure begins by massaging the neck muscles, while simultaneously tilting the head to the sides. Massage techniques are performed symmetrically and follow the outflow of lymph, but the lymph nodes remain outside the area of influence. When a child begins to scream and be capricious, such a reaction indicates pain in this area. All techniques should be light, applied superficially, which will bring minimal pain to the child.

What you can do at home

After the child has completed the entire course under the supervision of a doctor, treatment can be continued at home. Parents can perform light massage, but only its use should be regular. Physical exercises are required with your child; they must be performed every day. It is necessary to monitor the regular intake of medications prescribed by a neurologist.

Operation

There are few indications for surgical intervention for facial paresis in a newborn. First of all, the indication is anomalies in the development of the openings in the skull through which the nerves exit the cranial cavity, or other disorders. It is indicated to remove the tumors that caused the paresis; after surgery, nerve function is restored.

Surgery will be required if the nerve is damaged; after its integrity is restored, facial expressions gradually return. However, such surgical intervention is carried out in the first months after the birth of the child, until muscle atrophy occurs and the nerve can activate them. There are congenital pathologies in which autotransplantation is performed, when a healthy nerve is taken from the child’s leg, sewn under the skin of the face, connecting it to the ends of the facial nerve. The transplant begins to control the muscles; at an older age, it becomes impossible to notice traces of the disease, movements are restored, and only a small scar located behind the ear speaks about the experience.

Classification

Facial nerve paresis in newborns is divided into the following types:

Central.
Congenital.
Peripheral.

Most often, children experience peripheral paresis. Sometimes local compression of the nerve fibers on the face occurs. Doctors call this condition Bell's palsy.

Peripheral paresis is characterized by:

Hypotonicity of muscle tissue.
Asymmetrical facial appearance.
When you try to close your eye, the pupil points upward.
Saliva flows from the mouth.
The place where the nerve is pinched hurts.
Dry mouth.
Hearing problems.
The voice is distorted.
The eye is poorly moisturized and lacrimation increases.

Central paresis occurs as a result of birth injuries, and a brain disorder or stroke is diagnosed.
Additional signs:

The muscles on the face weaken.
Hemiparesis.
Often both sides of the face become clogged.
The functionality of the muscles on the upper part of the face is preserved.
No taste disturbance is observed.
Congenital paresis occurs when there are defects in the formation of the facial nerve.

Classification by severity:

Slight asymmetry, the eye closes normally, the eyebrows are slightly frowned, the sucking reflex is difficult to reproduce, the corner of the mouth is directed downward.
The baby cannot perform the actions necessary for functional diagnostic testing. Such procedures are performed taking into account the age category, since children do not understand human speech. Therefore, such diagnostics are carried out in a state when the baby is crying or is able to smile on his own in his sleep.
The last degree has a complex course, the symptoms worsen. The eyes do not close, asymmetry is clearly visible, diagnostics reveals the presence of defects and problems with chewing function.

Causes

Let's list the main ones:

Neuritis or inflammatory process.
Compression of a nerve branch after an injury.
Infection.
Hypothermia.
Virus.
Surgery to combat other disorders.
Otitis.
Sometimes paresis occurs after infection in the nerve tissue.
Congenital syphilis.
New education.
Mumps.
Polio.
Osteitis is a disorder of sebaceous cells, problems with blood vessels or bone tissue.
Central paresis occurs when the brain is damaged.

The congenital form occurs with various developmental defects of the child.

Symptoms

Problems with muscle tone in newborns are clearly visible. The face is deformed on one side or both. The ear or the tissue around it may hurt. There is constant tearing or drying of the eye. It is difficult for the child to breastfeed, he does not want to eat, milk flows out of the mouth.

Sensitivity to loud sounds increases and tearfulness in the newborn increases. The eyes are wide open, and lagophthalmos appears in the affected area.

Acute symptoms are diagnosed within 2 weeks. The subacute phase lasts for a month. Then the disorder becomes chronic if left untreated.

Diagnostics

We list the common methods:

Primary testing is for the ability to smile, wince, sucking function, use of lips in a calm state or during a cry.
Consultation with other doctors is carried out in order to exclude the development of neoplasms and various pathologies.
Electromyography allows you to determine the speed of passage of a nerve signal.
CT scan.
An MRI helps rule out possible brain damage.

What are the complications?

If the child is treated correctly, the prognosis will be positive. Sometimes it is difficult to restore the functioning of the facial muscles, and involuntary contraction may occur.

Sometimes vision problems arise because a baby suffering from facial nerve paresis is unable to close his eyes, the mucous membrane dries out and peels off over time. As a result, the child loses his vision.

Treatment recommendations

To cope with such paresis, you need to contact a specialist as soon as possible. The doctor will conduct an accurate diagnosis, give some advice, and help cope with the symptoms.

Here are the recommendations:

It is necessary to protect damaged areas under the influence of input. There should be no draft in the room where the baby is. During walks you will have to cover your face with a cloth.
The room where the child is located should not be noisy. It is not advisable to use rattles or shout during entertainment.
If the cause of the cut is some kind of pathology, you need to treat it.

Drug therapy

We list the medicine that is used to eliminate signs of paresis:

An anti-inflammatory agent that helps relieve swelling.
Vitamins.
Blood thinning medications.
Hormonal drugs.
Corticosteroids.
Moisturizing eye drops.
Anesthetics.

Physiotherapy

To combat such disorders, a warming procedure is used. Hot paraffin may be involved. Sometimes a simple cloth is used, which is preheated.

It should be soft and natural material. If you use low-quality fabric, allergic reactions and skin rashes may occur. Ultrasound therapy is used to eliminate precision and pain symptoms.

Massage procedures gymnastics

Specially developed massage techniques make it possible to strengthen the muscles on the face and increase their tone. You can press your finger on the baby's lips when he pulls them into a tube. If you touch the cheeks near the mouth, the baby will begin to move his lips to feel the mother's breast. Thus, the muscle tissue will be strengthened.

Massage procedures help increase tone and improve the conductivity of nerve fibers. It is necessary that all manipulations are carried out with moderate force, the direction of massage should correspond to the treatment of lymph, the location of the lymph nodes has an undesirable effect on the skin. It is necessary to stroke the neck muscles without touching the spine.

Having entrusted such manipulations to a specialist, after some time you can carry out a massage at home, following all the instructions. To get the desired result, massage must be performed regularly at least once a day.

Surgical intervention

What procedures are carried out in the most difficult situations in order to prevent a decrease in muscle tone on the face:

If the nerve fibers are completely torn, surgery is performed to repair them.
Autotransplantation, in which a normal one is sutured instead of a congenital effective nerve.
Removal of the tumor compressing the fibers.
Plastic surgery.

Helping a child at home

When parents have become familiar with all the features of the course of therapy, they can send the child home and engage in treatment at home. You need to do some physical exercise every day.

Medicines must be taken regularly. The neurologist prescribes the necessary medications, dosage, and determines the duration of the course of treatment.

Forecast

In newborns, the disease develops favorably, and there are no complications if treated in a timely manner. Mild paresis is eliminated without intervention. To avoid the occurrence of contractures, after diagnosis you need to engage in therapy and follow all the doctor’s instructions.

Caring for a newborn contributes to his recovery, improving the functionality of the muscle responsible for facial expressions. Developing disease is rarely diagnosed. Isolation and tension of the tissues, in which the corner of the mouth is directed downward, indicates the presence of pathology.

Prevention

It is necessary to register with the antenatal clinic to determine possible circumstances and the nature of the destruction. If there is a possibility of complications, you can prepare and reduce the risk of negative consequences. Prevention is carried out even during childbirth, if it occurs through natural channels.

The girl needs to avoid the effects of infections on the body; after the birth of the baby, she needs to pay a lot of attention to them, to prevent hypothermia or inflammation. A child develops otitis media; the disease must be diagnosed and treated in time.

If you follow all preventive recommendations, the likelihood of developing paresis will be reduced. The possibility of illness must be prevented after childbirth. When the first signs appear, you need to go to the doctor; if you try to help the child on your own, health problems may arise.

Parents are not able to determine the disease based on external symptoms. To accurately make a diagnosis, you need to conduct several examinations using special medical equipment. Doctors often make a diagnosis after childbirth if paresis occurs due to abnormal formation of nerve fibers. Even with an external examination, it is possible to identify diseases. In some situations, electroneuromyography is performed.

Forecast

In a newborn, the pathology proceeds more favorably; complications with timely treatment are reduced to almost zero. Mild paresis may go away on its own. To avoid the appearance of contractures, after diagnosis, treatment begins and all doctor’s instructions should be followed.

Caring for a child contributes to his recovery and restoration of the functioning of facial muscles. It is rare to encounter a long-term and persistent disease. This can only indicate that the nerve core is decreasing. Isolated muscle tension, in which the corner of the mouth is lowered, indicates the congenital nature of the pathology.

Prevention

It is not for nothing that a woman registers with a consultation; this is done with the aim of predicting childbirth, and in the event of a threat of complications, carrying out delivery with minimal consequences. Prevention of nerve paresis is carried out during childbirth if it occurs through natural channels. A woman must protect her body from infections during pregnancy; after the birth of a child, she needs to take care of him, preventing him from hypothermia and infection. Otitis media is a pathology that must be promptly identified and treated.

Compliance with all preventive measures reduces the risk of developing facial nerve paresis significantly. During pregnancy, a mother should think not only about her health, but also about the child. After his birth, it is necessary to prevent the risk of the baby becoming ill. If symptoms of the disease appear, it is better to visit a doctor immediately; self-medication may have consequences for the child’s health.