Trauma to the facial nerve commonly occurs as it emerges from the stylomastoid foramen, and this can cause facial paralysis (Fig. 33-4). The incidence, which ranges from 0.2 to 7.5 per 1000 term births, is likely inluenced by the vigor with which the diagnosis is sought (Al Tawil, 2010; Moczygemba, 2010). Facial paralysis may be apparent at delivery or may develop shortly after birth. It most frequently is associated with uncomplicated vaginal delivery. However, in one series, a fourth of cases followed cesarean delivery (Alexander, 2006; Al Tawil, 2010). Facial nerve damage is likely more common with low forceps (Levine, 1984). It is possible that damage is caused by pressure exerted by the posterior blade when forceps have been placed obliquely on the fetal head. In these cases, forceps marks indicate the cause of injury. Spontaneous recovery within a few days is the rule, however, permanent paralysis has been described (Al Tawil, 2010).
Most long-bone fractures follow diicult deliveries, however, this is not always the case. At minimum, palpation of the clavicles and long bones is indicated for all newborns after a diicult delivery. Crepitation or unusual irregularity should prompt radiographic examination.
Clavicular ractures are common, unpredictable, and unavoidable complications of normal birth. heir incidence averages 5 to 10 per 1000 live births (Linder, 2012; Moczygemba, 2010). Other than female gender, no speciic risk factorsincluding birthweight and mode of delivery-have been identiied. Clavicular fractures protect against brachial plexopathy when there is shoulder dystocia (Wall, 2014).
ion No. 11, August 2017f r� haudharitBt, eased risk for respira-
HumeraL ractures are infrequent, and 70 percent follow an uneventful birth (T urpenny, 1993). Others are associated with diicult delivery of the shoulders in cephalic deliveries and of an extended arm in breech deliveries. Radiographically, they are often of the greenstick type, although complete fractures and distal humeral epiphyseal fractures can occur (harakan, 2016).
FemoraL ractures are rare and usually are associated with vag inal breech delivery. hey occasionally follow cesarean delivery, and in one report, they were bilateral (Cebesoy, 2009). Because most breech-presenting fetuses now undergo cesarean delivery, most of these fractures are associated with this mode (Alexan der, 2006; Cebesoy, 2009).
MandibuLar .ractures have been reported, are rare, and have been reviewed by Vasconcelos and coworkers (2009). he rare cases of cervicaL vertebraL disLocation in fetuses delivered as breech or after the Zavanelli maneuver were discussed earlier (Ross, 2006). Finally, rib ractures are occasionally encountered (Khan, 2016).
Sternocleidomastoid muscle injury in the past was usually seen with vaginal breech delivery. Hematomas of the muscle or the fascial sheath may resolve slowly with cicatricial contraction. With normal neck growth, the less-elastic damaged muscle does not elongate appropriately. As a result, the head is gradually turned toward the side of the injuy-torticoLis.