The image description explains it.

Five days after sustaining a compound fracture of his right arm, this 14-year-old boy noticed that he had blurred vision. Four days later, he could not swallow, move his lips, or protrude his tongue. Other findings included bilateral total ophthalmoplegia with ptosis (left) and dilated, fixed pupils (right). His mental status and sensory examination were normal. When symmetric, descending cranial nerve paralysis develops four to 14 days after an open injury and spares mental and sensory function, think of wound botulism. In this patient, culture of serosanguineous fluid from the fracture site grew Clostridium botulinum.

I think this is shown in the pictures. Lack of facial muscle control.

The muscle weakness of botulism characteristically starts in the muscles supplied by the cranial nerves—a group of twelve nerves that control eye movements, the facial muscles and the muscles controlling chewing and swallowing.