Family history of congenital palsy

History of birth trauma

Symptoms of dry or irritated eyes

Feeding problems or speech difficulties

Lack of lateral eye movement (Moebius syndrome)

Observe facial movement during conversation/build rapport with patient

Sequentially test facial nerve function of all branches on both sides

Test for Bell’s reflex: Hold eyelid open as patient actively tries to close eye

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  This is a protective phenomenon

Inspect sclera for signs of irritation/dryness

Look for lower eyelid malposition

Donor nerves: Test for contralateral buccal branches of facial nerve (smile), ipsilateral nerve to masseter (bite), spinal accessory nerve (shoulder shrug), and hypoglossal nerve (tongue movement)

Obtain computed tomography (CT) scan, only if there is concern for concomitant craniofacial microsomia

Best managed by a multidisciplinary team: Plastic surgery, pediatric otolaryngology, neurosurgery, pediatrics, speech pathology, child psychology, nutrition, social work, and nursing.