A Difficult Labor and Delivery Can Cause Damage to an Infant’s Cranial 7 (Facial) Nerve
Many injuries that occur during the labor and delivery process are minor, and even though these minor injuries may be alarming to see, will get better on their own in time. For example, it is not unusual for an otherwise healthy newborn to have some minor bruising, discoloration, or even a temporary elongation of the head after being born. However, other injuries are not minor and not always as visible. For example, damage during the birth process to the brachial plexus, spinal cord, or cranial nerves can lead to problems in newborns such as palsy or paralysis.
Factors that may contribute to damage to the Cranial 7 nerve include:
- Epidural anesthesia
- Pitocin, or other drugs to speed labor and cause stronger uterine contractions
- Pregnancy goes past safe or expected due date
- Long or difficult labor (either assisted or unassisted)
- Large baby
A study published in 2015 on facial nerve paralysis in children offers some alarming statistics and cautionary advice regarding treatment:
Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes.
Facial nerve paralysis in children can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic.
A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.
Most birth injuries to the Cranial 7 nerve only affect the lower part of the facial nerve (but this is not true in all cases). This nerve controls the muscles around the lips, which can make your baby’s smile and other facial features seem asymmetrical. Look for the following signs and symptoms:
- Your baby’s eyelid may not close on one side.
- When your baby cries, his/her face appears uneven (one side does not match what the other is doing.)
- Mouth movements (smile, crying, etc.) are not mirroring each other (both sides of mouth should curl in a smile.)
- No facial movement on the affected side of the face.
In severe cases, a baby may have paralysis from the forehead down to the chin.
Treatment options vary depending upon the individual patient, the cause of the facial paralysis, and how damaged the nerves are, but may include:
- Drug Therapy – Drugs may be used to help minimize symptoms or discomfort. In children, this may include the use of glucocorticoids (such as prednisone) in combination with antiviral therapy (acyclovir or valacyclovir).
- Surgery – Surgical decompression of the facial nerve is not generally recommended on babies and children, however, may be candidates for surgery for dynamic facial reanimation such as muscle transfers and nerve grafts.
- Rehabilitation – Physical therapy, electrical nerve stimulation, biofeedback, massage therapy, and exercises may provide some relief.
- Injections – New treatment approaches include the use of botulinum toxin after a cross facial nerve grafting.
- Advancements in Treatment – New treatments are being explored or are on the horizon, including stem cell therapy to regenerate nerves, and the use of bioelectrical technology to stimulate and regenerate damage facial nerves.
Prognosis and The House-Brackmann Facial Nerve Grading Global Score
It is not always possible to offer a prognosis as each child’s situation is unique. Although young children may recover on their own, and babies who suffered nerve damage due to perinatal trauma can recover on their own by the age of four months, up to 5% of babies suffering a birth injury related palsy will not recover on their own.
There are some measures used to help determine the prognosis of specific injuries, one of which is a grading scale to assess damage and predict the chances of recovery. This grading scale is called the House-Brackmann Facial Nerve Grading Global Score (HBFNGS). Patients with partial paralysis have a better prognosis.
According to House-Brackmann scale, those with a grade degree score of II have a good outcome, while those with grade III and the IV degrees are associated to moderate residual dysfunctions. Those with V and the VI degrees have poor possibility of recovery.
Did your baby suffer a birth injury as the result of a medical negligence or malpratice?
If you, or your baby suffered a severe injury as the result of medical neglect or malpractice you may be entitled to compensation. If you have questions about what happened and why your baby was injured, don’t trust an insurance company or doctor to provide you with all the information you need, call our lawyers today and take your first step in protecting you and your baby’s rights.
We offer a free legal consultation so you can tell us about your unique situation. We will be able to tell you if you have a case, the value of your case, and discuss your various legal options. We encourage you to at least talk to us and learn what your rights are so that you will have knowledge to help you make the best decision for your family about how to protect those rights for your child.
The Los Angeles area law firm of Donahue & Horrow, L.L.P., handles birth injury cases throughout California. The initial consultation will be at no cost. All cases are billed on a contingency fee basis — there will be no cost to you unless or until we recover compensation in the form of an insurance settlement or trial award.
Contact us today and you will have taken your first step towards ensuring your child’s future needs will be met.