Facial Nerve Paralysis in Children

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Original Editor

Top Contributors - Carina Therese Magtibay, Habibu Salisu Badamasi, Chelsea Mclene, Rishika Babburu and Mila Andreew  

Original Editor - User Name
Top Contributors - Carina Therese Magtibay, Habibu Salisu Badamasi, Chelsea Mclene, Rishika Babburu and Mila Andreew

Introduction

Facial Palsy is one of the most common cranial nerve dysfunctions in children and is a frequent presentation in pediatric emergency facilities. Spontaneous recovery is noted in the majority of the cases and prognosis correlates with age and severity of paralysis. Although less common in children than in adults, facial paralysis can have a huge impact on a child's life as well as the family especially if left untreated.

Clinically Relevant Anatomy

For an in-depth discussion on the facial nerve anatomy, please head to the Facial Nerve page.

Mechanism of Injury / Pathological Process

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Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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Causes

There are several causes of facial nerve paralysis in children. its can be cause by congenital or acquired.

Congenital

This may be due to traumas during birth, as well as hereditary or malformative disorders.

• Delivery trauma: Mother's first child, birth weight larger than 3500 g, use of forceps, cesarean birth, and prematurity are the main known risk factors for traumatic facial paralysis.
• syndromic malformation: can be one of the following:

1. Möbius syndrome: It is reported to be due to hypoplasia of the motor nuclei of the cranial nerves within the brainstem, probably due to a hypoxic-ischemic encephalopathy.
2. Goldenhar syndrome : Also known as hemifacial microsomia, with a spectrum of congenital malformations involving the structures derived from the first and second branchial arch), can also present a congenital facial paralysis.
3. Congenital pseudobulbar palsy (Syringobulbia) : is a condition that clinically manifests with facial paralysis, dysphagia and speech difficulties.
4. Arnold-Chiari syndrome: Congenital facial paralysis is usually associated to other cranial nerves paralysis (especially the VI one) due to malformations of the posterior fossa that allow herniation of brain structures through the foramen magnum.

• Hereditary myopathies: such as myotonic dystrophy and myasthenia, are among the genetic causes of facial nerve paralysis. Two loci (chromosome 3q21-22 and 10q21.3-22.1) have also been found to be responsible for isolated hereditary types of facial paralysis.

Acquired

Facial paralysis can frequently be due to viral infections.

Herpes Varicella-Zoster may be responsible, even in children, of Ramsay Hunt syndrome (zoster oticus); in this case, facial palsy can be associated to the presence of vesicular lesions of the external auditory canal and/or of the auricular concha. The incidence of this syndrome under 10 years of age is reported to be 2.7/100000.

Not frequently, a bilateral facial nerve palsy may be the onset of a Epstein-Barr virus, Haemophilus influenza, tuberculosis or Borrelia burgdorferi infection.

Lyme disease has become the most common cause of acute facial paralysis in children in those areas where Borrelia Burgdorferi infection is endemic. Other agents that may cause facial nerve palsy in children are cytomegalovirus, adenovirus, rubella, mumps, Mycoplasma pneumoniae and HIV.