Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of congenital bilateral facial nerve palsy (CN VII) and abducens nerve palsy (CN VI). History significant for mask-like facies, inability to smile, and impaired lateral ocular gaze. Associated symptoms include feeding difficulties, drooling, and potential limb anomalies. No history of progressive neurological decline.
Clinical Examination Findings
Craniofacial exam reveals bilateral facial paralysis, micrognathia, and high-arched palate. Ocular exam confirms absent lateral gaze bilaterally with preserved vertical gaze. Oral cavity shows tongue atrophy or fasciculations. Musculoskeletal exam assessed for syndactyly, clubfoot, or pectoral muscle hypoplasia (Poland sequence).
Treatment Protocol
Surgical management plan: 1. Dynamic facial reanimation (e.g., free functional muscle transfer/gracilis flap). 2. Static suspension procedures for facial symmetry. 3. Orthodontic intervention for malocclusion. 4. Speech and physical therapy for oral motor function. 5. Ophthalmological monitoring for corneal exposure and strabismus correction.