ABSTRACT
Advances in microsurgical techniques and reconstruction of the injured plexus by grafting from the dural nerve can significantly improve the functional result.48,52,53
Facial nerve injury Facial palsy secondary to birth trauma is usually unilateral and most commonly follows compression of the peripheral portion of the nerve, either near its emergence from the stylomastoid foramen or where the nerve transverses the ramus of the mandible. The mechanism of injury is usually either direct trauma from forceps or compression of the side of the face and nerve against the sacral promontory. The affected infant has absent or decreased forehead wrinkling, a persistently open eye, a decreased nasolabial fold and flattening of the corner of the mouth on the affected side (Fig. 3.7). Treatment is conservative, since spontaneous recovery occurs within 1 month in most cases of birth-related facial palsy.15,47 Initial treatment should be directed at protecting the corneal epithelium from drying with the use of methylcellulose drops instilled every 4 hours. Rarely, there is need for surgical intervention and neurolysis or a nerve cable transplant for the injured or degenerative facial nerve, after confirming the diagnosis by electromyographic and electroneurographic tests.54
