CASE-REPORT - UNILATERAL COMBINED FACIAL-NERVE AND BRACHIAL-PLEXUS PALSIES IN A NEONATE FOLLOWING A MIDLEVEL FORCEPS DELIVERY

A case is described in which the 2.7-kg fetus of a nonobese primigravi d patient, delivered by midlevel forceps manipulation sustained neurap raxias of both the marginal mandibular branch of the seventh cranial n erve and the upper trunks of the ipsilateral brachial plexus. The preg nancy was uneventful, but labor was complicated by an occipitoposterio r presentation and a prolonged second stage. Examination of the neonat e revealed bruising and skin markings consistent with injury by obstet ric forceps and the anatomic location of these marks suggested that ce rvical and mandibular compression from the forceps, rather than tracti on by the accoucheur, would account for the observed findings. A revie w of the English language literature over the past 30 years revealed o nly four cases in which a combination of facial nerve and brachial ple xus injuries could both be linked to obstetric instrumentation.