(Bell's palsy, a frigore facial paralysis)

Rare.

Symptomatology:

• peripheral,

-        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

• central: idem but the patient can close the eyes

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