Newborn scalp, skull, oral, and facial examination
THE CONTEXT
The neonatal examination distinguishes birth-related scalp swellings and facial weakness from benign findings that resolve spontaneously.
Scalp swellings
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Caput succedaneum is common, lies in the subcutaneous plane, and is diffuse, crossing suture lines. Its size and firmness are maximal at birth.
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Cephalohematoma is less common and lies over the parietal bones between the skull and periosteum. It has distinct margins, does not cross suture lines, and increases in size for 12–24 hours before becoming stable.
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Cephalohematoma is associated with linear skull fracture in 5–25% and with hyperbilirubinemia.
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A chignon following ventouse delivery resolves without treatment in a few days.
Benign oral, ocular, and skull findings
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Natal teeth may be present on the alveolar ridge.
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An Epstein pearl is a white retention cyst at the apex of the hard palate that disappears in a few weeks.
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Subconjunctival hemorrhages are common after vaginal delivery and resolve spontaneously.
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Craniotabes results from delayed ossification of skull bones, which may feel like a ping pong ball. It is benign and resolves spontaneously.
Facial asymmetry and neck examination
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Birth-related facial nerve paresis causes asymmetry during crying, with an open eye and absent nasolabial fold on the affected side and deviation of the mouth toward the normal side.
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Absence of depressor anguli oris can mimic facial nerve palsy, but the eyes remain tightly shut during crying and the nasolabial fold remains intact.
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The neck should be examined for masses such as an enlarged thyroid gland or sternomastoid tumor.