Facial nerve paralysis
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(Bell's palsy, a frigore facial paralysis)
Rare.
Symptomatology:
- loss of skin folds of the forehead on the affected side
- asymetric smile with loss of nasolabial fold on the affected side (or straight face if bilateral)
- partial loss of taste, drooling
- speech difficulties
- drooping and difficulty to close the eyelids (risk of lagophtalmia), loss of eye blinking
- hyperacusis
Causes of facial paralysis in children and adolescents:
- infectious: Lyme disease (typically bilateral, especially in summer time and in the autumn), badly treated acute otitis, infectious Mononucleosis, Kawasaki disease (see this topic), parotidis
- local zona (herpes zoster infection) : Ramsay-Hunt syndrome
- tumor: hemangioma of the neck, parotid tumor, brain tumor, recurrence of leukemia, methotrexate toxicity, histiocytosis
- traumatic: petrosal or temporal bone fracture, trauma after forceps delivery
- congenital: Moebius syndrome (see this topic), Melkersson-Rosenthal syndrome (see this topic), oto-mandibular syndrome, sometimes in case of ear aplasia
- idiopathic or 'a frigore' (or Bell's palsy): generally of sudden onset, unilateral; sometimes seems due to a primary or a reactivation of infection with a herpes virus. Corticotherapy is not recommended in children; spontaneous recovery usually within a few weeks
- iatrogenic: after surgery of the parotid gland, in the neck, around the VIII nerve or the posterior fossa
- high blood pressure
- neuromuscular: myasthenia gravis, myotonic dystrophy
- diabetes mellitus
Rare: congenital facial paralysis of the lower lip due to agenesis of the triangular muscle of the lower lip: this causes a defect of lowering of the labial commissure when crying. Sometimes associated with cardiac anomalies !
Anesthetic implications:
eye protection; depending on the cause
References :
- Pavlou E, Gkampeta A, Arampatzi M.
Facial nerve palsy in childhood.
Brain & Develop 2011; 33: 644-50.
- Drack FD, Weissert M.
Outcome of peripheral facial palsy in children: a catamnestic study.
Eur J Paediatr Neurol 2013; 17: 185-91.
Updated: June 2014