Treatment of infants with facial palsy.

A facial palsy developing at birth may be developmental or acquired. The developmental facial palsies are rare but are associated with Mobius's syndrome, hemifacial microsomia, microtia, and weakness of the depressor anguli oris. The acquired palsies mostly result from birth trauma. In a large series in the United States congenital VIIth nerve palsy had the incidence of 2 1 per 1000.1 Obstetric forceps, although used rarely, were found to have accounted for most of these facial palsies. Nevertheless, when forceps were applied, 90% recovered, leaving only 10% that did not resolve. In our series of 52 children with established facial palsy, 14% of mothers gave a history of obstetric difficulties in respect of use of forceps, large birth weight, or prolonged labour. A similar number of the obstetric population experienced these problems in delivery without complication. It is the treatment of permanent unilateral facial palsy that I will consider in this article. At birth the weakness of the hemiface becomes evident on crying with inability to close the eye and the angle of the mouth pulling towards the unaffected side. Considerable parental distress is engendered and a scapegoat sought. Clearly a great deal of parental support should be provided with the reassurance that most of these palsies settle spontaneously within a few months but if it is one of the rarer cases of permanent palsy, surgical treatment can be provided.