What is Congenital Facial Paralysis?
Congenital facial paralysis is a neurological condition that affects voluntary movements of the facial muscles and is present from birth. This neurological condition generally occurs in the facial nerve (7th cranial nerve) and is caused by congenital developmental disorders, birth trauma, or genetic syndromes. One of the most common causes of this condition is Moebius syndrome, which is typically characterized by bilateral facial paralysis. Additionally, the use of forceps during childbirth or prolonged difficult deliveries can cause nerve damage, leading to temporary or permanent facial paralysis.
The diagnosis of congenital facial paralysis is usually made through clinical examination, while imaging methods such as EMG and MRI can be used to assess the degree of nerve damage. Although the aforementioned treatment methods vary depending on the underlying cause, in most cases, physical therapy is used to strengthen the facial muscles. In more severe cases, surgical interventions such as cross-nerve grafting or masseter muscle transfer may be necessary. Therefore, it is essential to diagnose congenital facial paralysis as early as possible.
Causes of Congenital Facial Paralysis
As with any disorder, there are certain causes of congenital facial paralysis. These causes may occur during birth or may be genetic. In this context, if we look at the causes mentioned above;
- Moebius Syndrome
- Goldenhar Syndrome
- CHARGE syndrome
- Incomplete development or hypoplasia of the facial nerve (7th cranial nerve)
- Prolonged (extended) labor or difficult delivery process
- Macrosomia (large baby) causing compression in the birth canal
- Nerve compression or damage during birth
- Infections contracted in utero
- Insufficient oxygen supply to the baby
- Fetal neuromuscular developmental disorders
- Family history of facial paralysis
- Genetic mutations or chromosomal abnormalities
- In some cases, no obvious cause can be identified, and it may arise spontaneously during congenital development.
Symptoms of Congenital Facial Paralysis
The most prominent feature of congenital facial paralysis is facial asymmetry. This facial asymmetry may become more pronounced when the baby cries or moves its mouth. At this point, babies may experience inability to fully close their eyelids (lagophthalmos), weakness or loss of movement in the lips and cheek muscles, and difficulty sucking, feeding, and swallowing. This can lead to insufficient weight gain in newborns. In addition, excessive drooling and delays in speech development may be observed in later stages. If the facial paralysis is bilateral, the baby may have a blank, mask-like facial appearance and may have difficulty making facial expressions such as smiling or frowning.
In congenital facial paralysis associated with syndromes such as Moebius syndrome, additional neurological or skeletal system abnormalities such as eye movement disorders, limb deformities, and hearing loss may also be present.
Congenital Facial Paralysis Treatment Methods
There are various treatment methods for congenital facial paralysis. These treatment methods vary depending on the underlying cause of the paralysis, its severity, and the patient's functional needs. In mild cases, particularly in cases of temporary facial paralysis caused by birth trauma, spontaneous recovery may occur without the need for any specific treatment. However, in cases of permanent facial paralysis, physical therapy and exercises to strengthen the facial muscles are recommended. These exercises can help maintain muscle tone and support facial expressions.
In more severe and permanent cases of facial paralysis, surgical treatment options are considered. Techniques such as nerve grafting or nerve transfer (e.g., cross facial nerve grafting or hypoglossal-facial anastomosis) can help restore facial movement. Muscle transfer surgery can be performed by transplanting muscles from the legs or chewing muscles to the face, especially in cases where muscles have been immobile for a long time. For patients with eyelid closure problems, eyelid weighting surgery may be performed to protect the cornea.
How is Congenital Facial Paralysis Diagnosed?
Congenital facial paralysis is diagnosed by a detailed clinical examination immediately after birth. At this point, symptoms such as the absence of facial expressions on one side of the face, the corner of the mouth shifting to one side when crying, and incomplete closure of the eyelid are important clues for diagnosis in newborn babies. For this reason, a specialist physician uses imaging methods such as magnetic resonance imaging (MRI) or computed tomography (CT) to evaluate facial muscle movements and examine structural abnormalities in the facial nerve and surrounding tissues. Additionally, electromyography (EMG) may be performed to assess nerve conduction. In this context, if there is a possibility that a genetic syndrome is associated with facial paralysis, genetic testing and advanced laboratory investigations are also performed in addition to the diagnosis. In this way, congenital facial paralysis is comprehensively evaluated in terms of both the underlying cause and any associated anomalies.
Who does Congenital Facial Paralysis Affect?
Any baby can develop congenital facial paralysis, but some babies are at higher risk of experiencing it. If we examine these individuals in detail, we can say that they are the following babies:
- Newborn Babies
Congenital facial paralysis is most commonly seen in newborn babies. Especially in difficult births (such as those involving the use of forceps or vacuum extraction), pressure applied to the facial nerve in the birth canal can cause nerve damage. In such cases, symptoms such as loss of facial expression on one side of the face, inability to close the eyelid, and deviation of the mouth corner to one side while crying may appear immediately after birth.
- Genetic or Syndromic Babies
Some congenital facial paralysis is genetic in origin and occurs in conjunction with syndromes. For example, in Moebius syndrome, facial paralysis is typically bilateral and accompanied by other anomalies such as limited eye movement. Additionally, in syndromes such as CHARGE, Goldenhar, and Treacher Collins, facial paralysis may contribute to other abnormalities in facial and cranial development.
- Babies with Developmental Problems in the Womb
Abnormal development of the facial nerve in the womb can also cause congenital facial paralysis. Factors such as infections during pregnancy, certain medications, or exposure to toxic substances can negatively affect nerve development and lead to this condition.
- Babies with Bilateral Paralysis
In some cases, facial paralysis can affect both sides of the face rather than just one. This condition, which is particularly common in genetic syndromes, can lead to more serious problems such as feeding difficulties, inability to close the eyes, and complete loss of facial expressions.
Is Congenital Facial Paralysis Contagious?
Congenital facial paralysis is not a contagious disease. This condition occurs due to damage to the facial nerve before or during birth, or due to a developmental anomaly. In other words, it is not transmitted from person to person like infectious diseases. Therefore, there is no need to worry. However, in some cases, infections, medications, or toxic substances to which the mother is exposed during pregnancy may indirectly contribute to the development of this condition by negatively affecting the baby's nerve development. In this context, we can say that congenital facial paralysis is not contagious but is directly related to nerve damage or developmental abnormalities.
What is The Recovery Time For Congenital Facial Paralysis ?
The recovery period for congenital facial paralysis varies depending on the cause, severity, and treatment methods used. If the paralysis is due to pressure or nerve damage during birth, most babies with mild cases may show significant improvement within the first 3–6 months; in some cases, the nerve may even heal on its own and return to normal. However, in cases where the nerve has suffered severe damage or where the condition is caused by developmental anomalies (such as Möbius syndrome), the recovery process may be much longer or complete recovery may not be possible.
In such cases, physical therapy, facial exercises, and surgical interventions if necessary are used to aim for improvement in both function and aesthetics. Specialist physicians regularly monitor the baby's condition to determine which treatment methods and timeframes are appropriate. In short, the recovery period varies for each baby, and early diagnosis combined with a multidisciplinary approach enhances the success of the process.
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Can congenital facial paralysis be detected before birth?
Although it is generally difficult to detect with certainty before birth, cases associated with genetic syndromes can be identified through prenatal ultrasound or genetic testing. However, mild cases of congenital facial paralysis are usually noticed after birth.
Is congenital facial paralysis hereditary?
In some cases, it can be hereditary, especially when associated with genetic syndromes. However, many cases of congenital facial paralysis are caused by birth trauma or developmental anomalies and do not have a hereditary component.
Can people with congenital facial paralysis massage their faces?
Yes, but they should seek guidance from a physical therapist or specialist regarding the type and frequency of massage. Gentle and regular massage can increase circulation in the facial muscles and support muscle function. However, massage involving excessive pressure can damage the nerves.
Can congenital facial paralysis heal on its own?
In mild cases, especially congenital facial paralysis caused by birth trauma, it may heal on its own within a few months. However, facial paralysis caused by genetic or structural factors is typically permanent and may require physical therapy or surgical intervention.
