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Facial palsy as birth trauma — Clinical Guidelines

Overview

Facial palsy as birth trauma refers to the impairment of facial muscle function resulting from injury during childbirth, often leading to temporary or permanent asymmetry and functional deficits. 15

Diagnosis

Clinical assessment focusing on asymmetry, muscle strength, and presence of synkinesis.

Imaging studies (CT, MRI) may be necessary to rule out bony injuries or intracranial complications 12.

Ophthalmic evaluation crucial to assess for any vision-threatening injuries 12.

Management

Early intervention with physical therapy to prevent contractures and improve function 15.

Botulinum toxin injections for synkinetic movements if present 15.

Surgical options considered for severe cases involving bony structures or significant nerve damage 15.

Special Populations

Pediatrics: Pediatric facial trauma requires specialized care due to ongoing facial growth; multidisciplinary teams including plastic surgeons and otolaryngologists are essential 9.

Elderly: Older patients may have comorbidities affecting treatment choices and recovery; careful assessment for associated injuries is critical 7.

Key Recommendations

Conduct a thorough ophthalmic examination in all cases of facial trauma to prevent vision loss 12 (Evidence: Strong).

Implement multidisciplinary team approaches, including plastic surgery, otolaryngology, and ophthalmology, for comprehensive management 9 12 (Evidence: Moderate).

Early referral to specialized physical therapy is recommended to optimize outcomes in pediatric and adult patients 15 (Evidence: Moderate).

References

1 Gates H, Toogood G, Becker D. Emergent Facial Laceration Repair Variations Between Plastic Surgery, Otolaryngology, Ophthalmology, Emergency Medicine, and Oral Maxillofacial Surgery. The Journal of craniofacial surgery 2026. link 2 Malouf WT, Kondaveeti G, Phillips JG, Patel K, Hall JA, Fourrier TL et al.. Facial trauma education in radiology: using surgeon feedback as the benchmark for success. Emergency radiology 2024. link 3 Gervasio KA, Camarena J, Hampton J, Chopra N, Kalosza B, Shumate L et al.. Demographic and socioeconomic disparities in receipt of ophthalmology consultation for facial trauma. BMJ open ophthalmology 2023. link 4 Choi J, Traboulsi AA, Okland TS, Sadauskas V, Perrault D, Spain DA et al.. Evidenced-Based Practice Among Trainees: A Survey on Facial Trauma Wound Management. Journal of surgical education 2020. link 5 Mazzola RF, Mazzola IC. Fat Grafting in the Management of War Injuries. The Journal of craniofacial surgery 2019. link 6 Spencer CR. Sir Harold Delf Gillies, the otolaryngologist and father of modern facial plastic surgery: review of his rhinoplasty case notes. The Journal of laryngology and otology 2015. link 7 McCusker SB, Schmalbach CE. The otolaryngologist's cost in treating facial trauma: American Academy of Otolaryngology--Head and Neck Surgery survey. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2012. link 8 Paes JV, de Sá Paes FL, Valiati R, de Oliveira MG, Pagnoncelli RM. Retrospective study of prevalence of face fractures in southern Brazil. Indian journal of dental research : official publication of Indian Society for Dental Research 2012. link 9 Vasconez HC, Buseman JL, Cunningham LL. Management of facial soft tissue injuries in children. The Journal of craniofacial surgery 2011. link 10 Murphy AP, Doran HJ, O'Sullivan I, Sleeman D, Cusack SP. The McKesson prop--an essential tool for the emergency physician?. Emergency medicine journal : EMJ 2010. link 11 Bagheri SC, Dimassi M, Shahriari A, Khan HA, Jo C, Steed MB. Facial trauma coverage among level-1 trauma centers of the United States. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2008. link 12 Soparkar CNS, Patrinely JR. The eye examination in facial trauma for the plastic surgeon. Plastic and reconstructive surgery 2007. link 13 Le BT, Holmgren EP, Holmes JD, Ueeck BA, Dierks EJ. Referral patterns for the treatment of facial trauma in teaching hospitals in the United States. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2003. link 14 Zachariades N, Papavassiliou D, Christopoulos P. Blindness after facial trauma. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 1996. link80144-2) 15 Ellis DA, Wallace IR. Major facial trauma--the effect of legislation. The Journal of otolaryngology 1981. link 16 Rich JD, Zbylski JR, LaRossa D, Cullington JR. A simple method for rapid assessment of malar depression. Annals of plastic surgery 1979. link

Facial palsy as birth trauma