Neonatal facial nerve defect

Developmental unilateral facial palsy in a newborn: six cases and literature review

Unilateral facial palsy in a newborn is rarely caused by a developmental defect. It occurs either isolated or in the context of a syndrome. This article describes a multidisciplinary approach towards unilateral, isolated congenital facial palsy along with a literature review. We report six patients, three boys and three girls, who presented with a unilateral facial palsy at birth. Clinical assessment was performed by an ear-nose-throat (ENT) surgeon, a pediatric neurologist, and an ophthalmologist. Magnetic resonance imaging (MRI) of the posterior fossa and computerized tomography (CT) of the temporal bone were requested to exclude structural anomalies of the facial nerve. Imaging revealed the underlying cause in five patients out of six (80%), showing an ipsilateral facial nerve aplasia or hypoplasia. These findings point towards an underlying developmental defect and underscore the importance of MRI in the diagnostic work-up. Surgical and non-surgical therapies were discussed with the parents.Conclusion: Congenital unilateral facial palsy caused by a developmental defect outside the context of a syndrome is rare. A multidisciplinary approach is recommended to differentiate between various causes and to initiate timely treatment.What is Known:• Congenital facial palsy is mostly caused by environmental/external fcators.• However in rare cases it can be developmental defect.What is New:• This paper describes 6 cases of isolated congenital facial palsy related to a developmental defect and presents the largest case series in the literature caused by aplasia/hypoplasia of the facial nerve.• MRI and CT-imaging allow for an assessment of the facial nerve at the root entry zone of the brainstem and along its course through the middle ear or the face. Moreover, they proved to be helpful in differentiating between several causes of congenital facial palsy.

Developmental facial paralysis: a review

The purpose of this study is to clarify the confusing nomenclature and pathogenesis of Developmental Facial Paralysis, and how it can be differentiated from other causes of facial paralysis present at birth. Differentiating developmental from traumatic facial paralysis noted at birth is important for determining prognosis, but also for medicolegal reasons. Given the dramatic presentation of this condition, accurate and reliable guidelines are necessary in order to facilitate early diagnosis and initiate appropriate therapy, while providing support and counselling to the family. The 30 years experience of our center in the management of developmental facial paralysis is dependent upon a thorough understanding of facial nerve embryology, anatomy, nerve physiology, and an appreciation of well-recognized mishaps during fetal development. It is hoped that a better understanding of this condition will in the future lead to early targeted screening, accurate diagnosis and prompt treatment in this population of facially disfigured patients, which will facilitate their emotional and social rehabilitation, and their reintegration among their peers.

Congenital unilateral facial palsy and internal auditory canal stenosis

Congenital stenosis of the internal auditory canal is a rare clinical entity. The majority of patients exhibit sensorineural hearing loss, and preserve facial-nerve function. We present a patient who manifested congenital unilateral facial palsy and ipsilateral sensorineural hearing loss clinically. Neuroimaging demonstrated stenosis of the unilateral internal auditory canal and hypoplasia of the ipsilateral trigeminal, facial, and vestibulocochlear nerves, despite normal function of the trigeminal nerves. The functional prognosis of facial and vestibulocochlear nerves was poor, and cognitive development demonstrated borderline delay.

Facial nerve paralysis: A three year retrospective study

Of all the cranial nerves, the facial nerve is the one which is most commonly involved in disease. Facial paralysis leaves the patient severely disfigured. Timely diagnosis and treatment can lead to considerable recovery. 16 consecutive patients of facial paralysis of all age groups and due to different causes diagnosed and treated in a tertiary referral hospital have been studied retrospectively. The frequency of aetiological factors, the various factors governing the management of these cases and their actual outcomes after a minimum period of one year are discussed. The causes of facial nerve palsy included cholesteatomas, Bell's Palsy, iatrogenic, traumatic, neuroma and others. In general, early reporting, diagnosis and surgical intervention wherever indicated have resulted in better recovery. Surgical decompression of the facial nerve traditionally advocated have been questioned. Rare causes of facial nerve paralysis like postoperative BIPP pack allergy and bilateral congenital agenesis of facial nerve are also included.

Non-traumatic congenital facial nerve paralysis; electroneurophysiologic evaluation of four cases

Non-traumatic congenital facial paralysis is frequently due to intrauterine hypoplasia of the facial nerve and usually appears as a component of a syndrome. The experience about this problem is limited due to its rare occurrence and sometimes differential diagnosis of congenital facial paralysis of developmental origin from an acquired one in children and infants needs much effort. Controversy remains regarding the site of the lesion. Total facial paralysis is uncommon and inherited transmission has been reported on some occasion. Four children with congenital facial paralysis, whose family history is noncontributory, are presented in this report and the related literature is reviewed.

Facial nerve anomalies in association with congenital hearing loss

OBJECTIVE

Facial nerve (FN) anomalies are exceedingly rare. The association between a hearing loss and an anomalous facial nerve has never been touched deeply in the literature. The aim of this study is to report facial nerve anomalies in patients presenting with congenital hearing loss (COHL) and/or facial nerve palsy.

METHODS

A retrospective chart review over 10 years from two academic tertiary referral centers. Eight patients were diagnosed with facial nerve anomalies in association with congenital hearing loss. The age ranged from 7 months to 13 years.

RESULTS

Five patients had conductive congenital hearing loss (CCHL). Two had congenital sensorineural hearing loss (CSNHL). The eighth patient had a mixed hearing loss (MHL). Surgical findings for patients with conductive congenital hearing loss included facial nerve passing inferior to oval window (OW) (two patients), facial nerve covering head of stapes (three patients), deformed stapes (two patient), deformed incus (two patient), and absent incus (one patient). Radiological findings for patients with congenital sensorineural hearing loss and mixed hearing loss include, single cavity anomaly (one patient), dilated vestibule and superior semicircular canal (one patient), and absent internal auditory canal (IAC) (two patients). For patients with conductive congenital hearing loss, the radiological findings consistency demonstrates a soft tissue opacification in the middle ear.

CONCLUSIONS

Congenital hearing loss may be associated with facial nerve anomalies. Pediatric otolaryngologists should be cautious when exploring patients with conductive congenital hearing loss.

Möbius and Möbius-like patients: etiology, diagnosis, and treatment options

The surgical goal in Mobius patients is far more modest and differs from patients with unilateral developmental facial paralysis. It is impossible to restore a true smile in these mask-like, expressionless faces. Despite sophisticated microneurovascular transplantations, movement can only be restored along one vector and enhanced firmness in the cheeks, thus multiple differentiated facial animation is not achievable. A detailed neurological evaluation can identify possible motor donors or residual function, which can be used for additional dynamic restorations. Due to the multiple cranial nerve involvement a thorough clinical and electrophysiological examination is mandatory. In addition, electromyographic survey of the potential motor donors is very helpful to avoid weak wasted regeneration and prevent further downgrading of function. Because of the variety of cranial nerves involved in Möbius' syndrome, a standard procedure for dynamic restoration cannot and should not be promoted; instead, a careful preoperative objective and quantitative assessment should guide the reconstructive surgeon to the optimal reconstruction strategy. Useful movement can be restored in afflicted patients that may signal physical and psychological rehabilitation.

Mobius syndrome: electrophysiologic studies in seven cases

Mobius syndrome is characterized by congenital facial diplegia, frequent impairment of gaze, variable involvement of other cranial muscles, and various musculoskeletal anomalies. The site of dysfunction remains debatable. We performed detailed electrophysiologic studies in 5 children and 2 adults with Mobius syndrome to better delineate the pathophysiology of this disorder. Sensory and motor conduction studies were normal in the extremities. Facial compound muscle action potential amplitudes were reduced in all patients. The blink reflex R1 responses were unobtainable unilaterally in 2 patients and unobtainable bilaterally in 3 patients. Otherwise, R1 and R2 latencies were variably prolonged. The jaw jerk and masseter silent periods, tested in 2 patients, were normal. Detailed electromyographic studies of facial muscles revealed multifocal, chronic neurogenic changes. The findings indicate a brain stem process predominantly affecting the facial nuclei and their internuclear connections rather than a supranuclear or muscular site of involvement.