Acute Facial Nerve Palsy in Children: Gold Standard Management
Abstract
:1. Introduction
2. Methodology
3. Epidemiology
4. Causes of Facial Nerve Palsy
4.1. Bell’s Palsy
4.2. Infectious Causes
4.3. Other Causes
5. Diagnosis
5.1. History and Physical Examination
5.2. Grading System
5.3. Complementary Examinations
5.3.1. Laboratory Testing
- A full blood count and a blood film should be performed in cases of suspected leukaemia based on examination [29];
- Serological testing for Lyme disease is indicated in cases suggestive of possible tick exposure, in endemic areas, or for patients with erythema migrans [28];
- A lumbar puncture should be conducted when suspecting meningitis, Lyme disease or Guillain-Barré syndrome [21].
5.3.2. Diagnostic Imaging
5.3.3. Electrodiagnostic Testing
6. Treatments
6.1. Corticosteroids
6.2. Antivirals
6.3. Eye Care
6.4. Physiotherapy
7. Prognosis
8. Follow-Up
- ocular symptoms
- new or worsening neurological symptoms
- incomplete facial recovery after 3 months of evolution [28].
9. Future Directions
Author Contributions
Funding
Informed Consent Statement
Conflicts of Interest
References
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Causes | Examples |
---|---|
Idiopathic VII nerve palsy (Bell’s palsy) | Isolated—acute onset—unilateral—detailed history and examination are normal |
Infectious | Otitis media (4 to 37%) [11,19,20] Mastoiditis or cholesteatoma Herpes zoster (Ramsay Hunt syndrome) Epstein-Barr virus Lyme disease Tuberculosis Cytomegalovirus Adenovirus Rubella Mumps Human immunodeficiency virus (HIV) Haemophilus influenza Mycoplasma pneumoniae Syphilis Leprosy Cat scratch fever |
Neoplasia/malignancy | Posterior fossa tumours Parotid gland tumours Leukaemia Lymphoma Cholesteatoma |
Trauma/nerve compression | Perinatal trauma Temporal bone fracture Raised intracranial pressure Otic barotrauma Iatrogenic trauma (surgical procedures) Cleidocranial dysostosis Histiocytosis X |
Congenital/genetic | Arnold-Chiari syndrome Absence of depressor anguli oris muscle (cardiofacial syndrome) Inner ear or facial nerve malformation Moebius syndrome Syringobulbia Facioscapulohumeral muscular dystrophy Myotonic dystrophy Myasthenic syndromes |
Neurological | Guillain Barré syndrome Multiple sclerosis |
Inflammatory | Henoch-Schönlein purpura Kawasaki disease Sarcoidosis |
Metabolic conditions | Diabetes mellitus Hyperparathyroidism Hypothyroidism Acute porphyria |
Other | Hypertension Autoimmune issues (e.g., lupus) Pregnancy Haemophilia Melkersson-Rosenthal syndrome |
Signs | Possible Causes |
---|---|
History of trauma | Search for stigmata of temporal bone fractures: haemotympanum, traumatic perforation, Battle’s sign |
Gradual onset | Malignancy |
Tick bites or possible exposure | Lyme disease |
Erythema migrans | Lyme disease |
Arthritis | Lyme disease |
Bilateral involvement | Lyme disease, polyneuropathy |
Forehead sparing | Central nervous system cause |
Abnormal otoscopy | Acute otitis media, cholesteatoma |
Fever | Infectious cause (acute otitis media) |
Vesicular rash or blistering of the face or ear canal | Ramsay Hunt syndrome, herpes zoster virus infection |
Ear pain | Herpes zoster virus infection |
Rest of the neurological examination abnormal | Malignancy |
Examination of the neck: lymph nodes or mass | Malignancy |
High blood pressure | Malignant hypertension |
Stage | Description |
---|---|
I | No paresis: normal function |
II | Mild paresis: no deformity at rest |
III | Moderate paresis: obvious difference from the other side, no deformity at rest, synkinesis, total closure of eyelids at maximum effort |
IV | Moderately severe paresis: disfiguring asymmetry, synkinesis, eye closure incomplete at maximum effort |
V | Severe paresis: asymmetry at rest (ptosis of the labial commissure, effacement of the nasolabial fold), some visible residual movements |
VI | Complete paralysis: atony at rest, no active movement |
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Wohrer, D.; Moulding, T.; Titomanlio, L.; Lenglart, L. Acute Facial Nerve Palsy in Children: Gold Standard Management. Children 2022, 9, 273. https://doi.org/10.3390/children9020273
Wohrer D, Moulding T, Titomanlio L, Lenglart L. Acute Facial Nerve Palsy in Children: Gold Standard Management. Children. 2022; 9(2):273. https://doi.org/10.3390/children9020273
Chicago/Turabian StyleWohrer, Delphine, Thomas Moulding, Luigi Titomanlio, and Léa Lenglart. 2022. "Acute Facial Nerve Palsy in Children: Gold Standard Management" Children 9, no. 2: 273. https://doi.org/10.3390/children9020273