Facial Nerve Palsy in Pediatrics
Pediatric Facial Nerve Palsy: Divided into two groups:
1. Newborn: Incidence: 92/44292 cases (0.2% incidence)
(Plastic & Recon Surg 90;85:1-4)
Most are due to trauma of the birth process. Risk factors include the
use of forceps, primiparity, and the baby being over 3500 grams. If facial
palsy is bilateral, must consider congenital absence of VIIth nerve (Möbius
Syndrome)
Evaluation and treatment of newborn facial palsy: Be aware of the natural
history:
- 89% go on to have a full recovery without therapy
- 11% have an incomplete recovery
Most cases are clear at about 5 weeks of age; it is at this time you
should considerelectrophysiological diagnosis (does the nerve work?) and/or
surgical exploration (Laryngoscope 86;96:381-4)
2. Infant or Childhood Facial Nerve Palsy Causes:
Association with acute or chronic otitis media. The
mechanism of the facial palsy in this situation is that the facial nerve is
exposed from a congenital bony dehiscence within the middle ear. Treatment
is to perform a myringotomy; no other surgery should be necessary. Should
have almost 100% full recovery.
3. Idiopathic (Bell’s palsy)
a. Possible etiologies: Association with specific infectious agents:
- Varicella-zoster: most commonly associated organism. One study found
increased IgM and increased CF antibody to varicella-zoster.
- Increased IgM to herpes simplex found. (Journal of Infection
95;30:29-36)
- No association found with CMV, rubella, Borrelia, RSV, mumps, measles,
influenza in one study.
- Studies on Borrelia Burgdorferi. (Lyme disease) Well known that
facial nerve palsy (unilateral or bilateral) associated with Lyme. Some
studies have found increased titers to Borrelia. (Acta Oto-Laryngol. Supp.
1992;492:103-6)
b. Natural history of Bell’s palsy: complete recovery in 95% of cases (Pediatrie
92;47:481-6)
c. Treatment possibilities:
- Role of Steroids: Many different studies have been done trying
to determine if steroids are indicated in this problem. -J of Infection
95;30:29-36. 62 patients - No difference in treatment group; Laryngoscope
82;92:1369-73. 92 cases: no difference.
Rationale: in otitis media caused facial palsy, steroids could decrease
serous otitis.
- Acyclovir: if herpetic simplex infection present.
- Surgery: facial nerve decompression: rarely indicated unless
persistent.
Testing with electromyography: found that even if decreased, recovery
occurs withoutsurgery. Other surgeries suggested: mastoidectomy if
mastoid osteitis present.
4.
Miscellaneous causes of facial nerve palsy: lymphoma, other viral
infections, and temporal bone fracture.
Conclusion: If have a child with Idiopathic Facial Palsy, observe:
prognosis is excellent!
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