Clinical features and management of facial nerve paralysis in children: analysis of 24 cases

Delayed Lower Motor Neurone Facial Nerve Palsy Following a Traumatic Head Injury

Delayed facial nerve weakness secondary to head injury is rare. The mechanism of immediate facial nerve paralysis is obvious, however, the delayed presentation remains disputed. We report a 58-year-old gentleman who presents 6 days after being discharged following head trauma with a 2-day history of facial nerve paralysis (House-Brackmann grade 6). Computed tomography (CT) head showed a minimally displaced longitudinal squamous temporal bone fracture initially with nerve conduction studies and electromyograpy revealing a relative reduction in left facial motor amplitudes with moderate recruitment. He showed good progress following high-dose steroids and conservative management. Early involvement of ear, nose and throat (ENT) surgeons is crucial. The use of both high-resolution CT scanning and nerve conduction studies will help guide management as early as possible and improve outcomes in these patients.

Effect of etiological factors on treatment success of pediatric facial paralysis: Success of facial paralysis in children

Facial paralysis is a clinical condition that causes anxiety in the family and is one of the reasons for urgent admission to the hospital. The purpose of this article is to evaluate to reveal the relationship between etiology and treatment results in childhood facial paralysis.Thirty-three patients who presented with facial paralysis between May 2018 and May 2020, had adequate follow-up were included in the study. Data were reviewed age, gender, side, etiology, features of family, treatment, results, and recurrences.The ages of the cases ranged from 21 months to 17 years, with the mean age was 13.1 years. Ten of the cases were male (30.3%), 23 of them were female (69.7%). It was observed that 15 (45.4%) of the paralysis were on the right half of the face, 17 (51.5%) were on the left side of the face, and 1 (3.1%) had bilateral involvement. However, it was learned from the story that 3 cases had recurrence. Thirty-two (96.9%) of the cases were peripheral and 1 (3.1%) had central facial paralysis. No cause could be found in the etiology of other peripheral paralysis cases and it was considered as Bell Paralysis. According to the House Brackmann Stage at the time of admission of 30 patients who were given steroid treatment, 10 patients were evaluated as stage 6, 15 patients as stage 5, and 5 patients as stage 4. After 6 months of follow-up, 27 patients were evaluated as stage 1 and 2 patients as stage 2. Recurrence was not observed in any of the patients who recovered.It was concluded that etiology determines the success of treatment in facial paralysis.

Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy

BACKGROUND AND OBJECTIVES

Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW).

MATERIALS AND METHODS

In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW.

RESULTS

The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics.

CONCLUSION

The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.

Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients

Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis.

Surgical management of facial nerve paralysis in the pediatric population

BACKGROUND

In the pediatric patient population, both the pathology and the surgical managements of seventh cranial nerve palsy are complicated by the small size of the patients. Adding to the technical difficulty is the relative infrequency of the diagnosis, thus making it harder to become proficient in the management of the condition. The magnitude of the functional and aesthetic deficits these children manifest is significantly troubling to both the patient and the parents, which makes immediate attention, treatment, and functional restoration essential.

METHODS

A literature search using PubMed (http://www.pubmed.org) was undertaken to identify the current state of surgical management of pediatric facial paralysis.

RESULTS

Although a multitude of techniques have been used, the ideal reconstructive procedure that addresses all of the functional and cosmetic needs of these children has yet to be described. Certainly, future research and innovative thinking will yield progressively better techniques that may, one day, emulate the native facial musculature with remarkable precision.

CONCLUSION

The necessity for surgical intervention in children with facial nerve paralysis differs depending on many factors including the acute/chronic nature of the defect as well as the extent of functional and cosmetic damage. In this article, we review the surgical procedures that have been used to treat pediatric facial nerve paralysis and provide therapeutic facial reanimation.