 |
|
|
|
 Bookmark Health Information
 Make Health Information Homepage
|
 |
|
birth cranial nerve injury :
Unilateral branches of the facial nerve and vagus nerve, in the form of recurrent laryngeal nerve, are most commonly involved in cranial nerve injuries and result in temporary or permanent paralysis. Compression by the forceps blade has been implicated in some facial nerve injury, but most facial nerve palsy is unrelated to trauma. Physical findings for central nerve injuries are asymmetric facies with crying. The mouth is drawn towards the normal side, wrinkles are deeper on the normal side, and movement of the forehead and eyelid is unaffected. The paralyzed side is smooth with a swollen appearance; the nasolabial fold is absent; and the corner of the mouth droops. No evidence of trauma is present on the face.
Physical findings for peripheral nerve injuries are asymmetric facies with crying. Sometimes evidence of forceps marks is present. With peripheral nerve branch injury, the paralysis is limited to the forehead, eye, or mouth. The differential diagnosis includes nuclear genesis (Möbius syndrome), congenital absence of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial hemorrhage. Most infants begin to recover in the first week, but full resolution may take several months. Palsy that is due to trauma usually resolves or improves, whereas palsy that persists is often due to absence of the nerve.
Management consists of protecting the open eye with patches and synthetic tears (methylcellulose drops) every 4 hours. Consultation with a neurologist and a surgeon should be sought if no improvement is observed in 7-10 days. Diaphragmatic paralysis secondary to traumatic injury to the cervical nerve roots supplying the phrenic nerve can occur as an isolated finding or in association with brachial plexus injury. The clinical syndrome is variable. The course is biphasic; initially the infant experiences respiratory distress with tachypnea and blood gases suggestive of hypoventilation (ie, hypoxemia, hypercapnia, acidosis). Over the next several days, the infant may improve with oxygen and varying degrees of ventilatory support.
Elevated hemidiaphragm may not be observed in the early stages. Approximately 80% of lesions involve the right side and about 10% are bilateral. The diagnosis is established by ultrasonography or fluoroscopy of the chest, which reveals the elevated hemidiaphragm with paradoxic movement of the affected side with breathing. The mortality rate for unilateral lesions is approximately 10-15%. Most patients recover in the first 6-12 months. An outcome for bilateral lesions is poorer.
The mortality rate approaches 50%, and prolonged ventilatory support may be necessary. Management consists of careful surveillance of respiratory status, and intervention, when appropriate, is critical.
Hit: 688 times
 Print Health Information
Health Home
| |
|
|
|
|
|
Advertise with Draligus.org