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Silverman E, Matsumoto C, Wang HC, Ma L. Incomplete Bell's Palsy Following Influenza Vaccination in a 7-Month-Old. Clin Pediatr (Phila) 2023; 62:1318-1322. [PMID: 36994991 PMCID: PMC10548764 DOI: 10.1177/00099228231158366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Affiliation(s)
- Elizabeth Silverman
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chika Matsumoto
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Helen C. Wang
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Lawrence Ma
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
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Bhate M, Das AV, Singh S. Characteristics of facial nerve palsy in 112 children and risk factors for ocular complications. J AAPOS 2023; 27:141.e1-141.e5. [PMID: 37156335 DOI: 10.1016/j.jaapos.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/28/2023] [Accepted: 03/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To report the ophthalmic findings and ocular complications in a large cohort of pediatric patients with facial nerve palsy (FNP). METHODS Ocular data of children (≤16 years of age) diagnosed with FNP presenting to an eye care network from 2012 to 2021 were analyzed. Study parameters were etiology of FNP, ocular and imaging findings, degree of lagophthalmos, and degree of vision loss. Clinical characteristics were compared between those with and without moderate-to-severe vision impairment (best-corrected visual acuity <20/50) and those with and without exposure keratopathy at presentation. RESULTS A total of 112 patients were included. Mean age at presentation was 8.3 ± 5.0 years. The most common etiology was idiopathic (57%) followed by congenital (22.3%) and traumatic (13.4%). There was bilateral involvement in 8% of children, multiple cranial nerve involvement in 15.2%, and exposure keratopathy at presentation in 38.4%. One-fifth (20.5%) of children (29.6% of affected eyes with known visual acuity) had moderate-to-severe visual impairment. Multiple cranial nerve involvement was present in 31% of eyes with visual impairment compared with 14% of those without. Corneal scarring and strabismic amblyopia were both frequent causes of visual impairment. Most children with exposure keratopathy had lagophthalmos (76.6%), whereas it was less common in those without keratopathy (49.2%). CONCLUSIONS Pediatric FNP was most commonly idiopathic, secondarily congenital. Strabismic amblyopia and corneal scarring were the most common causes of visual impairment in our cohort.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Ophthalmic Plastic Surgery Services, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Acute Facial Nerve Palsy in Children: Gold Standard Management. CHILDREN 2022; 9:children9020273. [PMID: 35204994 PMCID: PMC8870855 DOI: 10.3390/children9020273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.
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Clinical Prognostic Factors Associated with Good Outcomes in Pediatric Bell's Palsy. J Clin Med 2021; 10:jcm10194368. [PMID: 34640384 PMCID: PMC8509832 DOI: 10.3390/jcm10194368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The prognosis of children with Bell’s palsy remains unclear due to its relatively low incidence, and thus, the small number of patients included in individual studies. To evaluate the prognosis of children with Bell’s palsy and identify the predictive value of specific factors that contribute to complete recovery, a retrospective cohort study was conducted of all patients with Bell’s palsy who visited the outpatient clinic of our university hospital between January 2005 and December 2020. We identified the parameters associated with a favorable recovery after 6 months in pediatric patients with Bell’s palsy. Factors recorded for each patient included age, sex, side affected by palsy, time between symptom onset and start of treatment, treatment methods, and the House–Brackmann grade (H–B) grade. The results of the multivariable analysis revealed that the lower degree of initial facial nerve paralysis presented as H–B grade II–IV was a significant favorable prognostic factor (OR: 3.86; 95% CI: 1.27–11.70; p < 0.05). Our results showed that the most important factor influencing the complete recovery of Bell’s palsy in children was the lower initial H–B grade at initial presentation.
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Kanerva M, Liikanen H, Pitkäranta A. Facial palsy in children: long-term outcome assessed face-to-face and follow-up revealing high recurrence rate. Eur Arch Otorhinolaryngol 2020; 278:2081-2091. [PMID: 33320295 PMCID: PMC8131306 DOI: 10.1007/s00405-020-06476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the long-term (minimum of 2 years from the palsy onset) outcome of pediatric facial palsy by patient questionnaire and face-to-face assessment by the Sunnybrook facial grading system, House-Brackmann grading system, and Facial Nerve Grading System 2.0. To compare the outcome results of self-assessment with the face-to-face assessment. To assess the applicability of the grading scales. To assess the palsy recurrence rate (minimum of a 10-year follow-up). METHODS 46 consecutive pediatric facial palsy patients: 38 (83%) answered the questionnaire and 25 (54%) attended a follow-up visit. Chart review of 43 (93%) after a minimum of 10 years for the facial palsy recurrence rate assessment. RESULTS Of the 25 patients assessed face-to-face, 68% had totally recovered but 35% of them additionally stated subjective sequelae in a self-assessment questionnaire. Good recovery was experienced by 80% of the patients. In a 10-year follow-up, 14% had experienced palsy recurrence, only one with a known cause. Sunnybrook was easy and logical to use, whereas House-Brackmann and the Facial Nerve Grading System 2.0 were incoherent. CONCLUSIONS Facial palsy in children does not heal as well as traditionally claimed if meticulously assessed face-to-face. Patients widely suffer from subjective sequelae affecting their quality of life. Palsy recurrence was high, much higher than previously reported even considering the whole lifetime. Of these three grading systems, Sunnybrook was the most applicable.
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Affiliation(s)
- Mervi Kanerva
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Hanna Liikanen
- Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Cayir S, Kilicaslan C. Hematologic parameters as predictive markers in pediatric Bell's palsy. Eur Arch Otorhinolaryngol 2020; 278:1265-1269. [PMID: 33159247 DOI: 10.1007/s00405-020-06459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze various hematological parameters in pediatric population with Bell's palsy (BP) and to determine the most valuable parameter as a prognostic marker. METHODS Fifty-nine patients with BP under 18 years were enrolled, and patients were divided into three groups: recovery group (49 cases), non-recovery group (10 cases) and controls (65 healthy children). Age, white blood cell (WBC), hemoglobin (Hbg), mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) were determined and compared between groups. Additionally, the receiver operating characteristics (ROC) analysis was carried out, and the most valuable marker to demonstrate the prognosis among these parameters was investigated. RESULTS While mean age was found as 10.69 ± 5.76 years, 28 (47.5%) female and 31 (52.5%) male pediatric patients were determined to be followed up due to BP in our hospital. When such parameters age, mean Hbg, MPV and RDW were examined, no significant difference was detected between groups. However, compared controls with recovery and non-recovery groups, WBC, NLR, PLR and CAR were found to be significantly higher, respectively (p < 0.05). Median CAR and NLR values were found to be significantly higher in non-recovery group, compared to those in recovery group (p = 0.001, p = 0.012, respectively). However, when median WBC and PLR were examined between recovery and non-recovery groups, no significant difference was observed (p > 0.05). CONCLUSION High NLR and CAR values in pediatric BP may be related to poor prognosis in such patients. CAR, however, is a more valuable parameter than NLR in terms of indicating poor prognosis.
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Affiliation(s)
- Serkan Cayir
- Department of Ear Nose and Throat and Head and Neck Surgery, Aksaray Education and Research Hospital, Aksaray University, 68100, Aksaray, Turkey.
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Hanci F, Türay S, Bayraktar Z, Kabakuş N. Childhood Facial Palsy: Etiologic Factors and Clinical Findings, an Observational Retrospective Study. J Child Neurol 2019; 34:907-912. [PMID: 31407620 DOI: 10.1177/0883073819865682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the etiologic factors, clinical characteristics, seasonal distributions, family history, response to corticosteroid therapy, recurrence and residual paralysis rates, and factors affecting these in pediatric facial palsy. Patients aged <18 years diagnosed with acute peripheral facial palsy were included in the study. Demographic data and clinical findings were retrieved from patients' records. The study was completed with 113 patients. Causes were idiopathic in 74 (65.4%) cases. Complete healing was not achieved in 6 (5.3%) patients, and recurrence was observed in 11 (9.7%). None of the patients with residual paralysis used corticosteroid, but all the patients with recurrence had employed them. We determined that young age may have an adverse impact on complication development and that corticosteroid therapy may be useful in the healing process in idiopathic facial nerve palsy. In conclusion, age may have an adverse impact in idiopathic facial nerve palsy, whereas corticosteroid therapy has a positive effect.
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Affiliation(s)
- Fatma Hanci
- Division of Child Neurology, Department of Pediatrics, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - Sevim Türay
- Division of Child Neurology, Department of Pediatrics, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - Zehra Bayraktar
- Department of Pediatrics, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - Nimet Kabakuş
- Division of Child Neurology, Department of Pediatrics, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
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Psillas G, Antoniades E, Ieridou F, Constantinidis J. Facial nerve palsy in children: A retrospective study of 124 cases. J Paediatr Child Health 2019; 55:299-304. [PMID: 30144181 DOI: 10.1111/jpc.14190] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/13/2018] [Accepted: 07/22/2018] [Indexed: 11/30/2022]
Abstract
AIM To report the causes and clinical evaluation of children with facial nerve palsy (FNP) admitted to an affiliated university hospital during a 5-year period (2011-2015). METHODS A total of 124 children were retrospectively categorised into two groups: idiopathic Bell's palsy (109 patients) and the second group into other FNP aetiologies (15 patients). All children received a standardised work-up and follow-up. Therapy consisted of steroid administration associated with antiviral treatment when a viral infection was suspected. RESULTS All children of the first group had a full recovery under oral steroids within 2 months of treatment. From the second group, seven children (46%) had a viral infection based on serological findings, two of them were positive for neurotropic herpes viruses, and one had Ramsay Hunt syndrome; six children with infectious FNP had recurrent FNP on the ipsilateral or contralateral side. Five patients had FNP as a complication of acute otitis media; three of them (60%) had partial or full recovery postoperatively. One child developed FNP following temporal bone trauma that had an uneventful recovery with conservative treatment. One child suffered from Melkersson-Rosenthal syndrome, and another child presented with FNP associated with unilateral hemiparesis following an ischaemic cerebral infarct. CONCLUSIONS Facial palsy in children is a manifestation of a heterogeneous group of causes. The most common aetiology of FNP in children in our study was idiopathic (Bell's palsy), followed by infective causes, such as acute otitis media and neurotropic herpes viruses. Therefore, treatment should be adapted to each patient depending on the underlying disease and severity of FNP.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Elias Antoniades
- 1st Academic Neurosurgery Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Fotini Ieridou
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Greene JJ, Tavares J, Mohan S, Jowett N, Hadlock T. Long-Term Outcomes of Free Gracilis Muscle Transfer for Smile Reanimation in Children. J Pediatr 2018; 202:279-284.e2. [PMID: 30054167 DOI: 10.1016/j.jpeds.2018.06.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/25/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate long-term outcomes of free gracilis muscle transfer (FGMT) for smile reanimation on smile excursion, facial symmetry, and quality of life in a cohort of children with facial palsy. STUDY DESIGN A retrospective analysis of 40 pediatric patients who underwent FGMT for facial palsy at the Massachusetts Eye and Ear Infirmary Facial Nerve Center was performed. Preoperative and postoperative photography and videography were used to quantify smile excursion and facial symmetry. Preoperative and postoperative quality of life was assessed with the Facial Clinimetric Evaluation (FaCE) survey, a validated, patient-based instrument for evaluating facial impairment and disability. RESULTS Of the 40 patients who underwent FGMT for facial palsy, 38 patients had complete data including preoperative and postoperative photography and videography from 3 months to 10 years following surgery; 13 cases had >5 years of follow-up. FGMT resulted in significant improvements in smile excursion within several months, with continued improvements in smile excursion and symmetry demonstrated more than 5 years later. Fifteen patients completed preoperative and postoperative FaCE surveys, which demonstrated significant improvement in quality of life scores following FGMT. CONCLUSIONS FGMT significantly improves smile, facial asymmetry, and quality of life for years after this surgery for facial palsy.
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Affiliation(s)
| | - Joana Tavares
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Suresh Mohan
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Nate Jowett
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Tessa Hadlock
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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Yoo HW, Yoon L, Kim HY, Kwak MJ, Park KH, Bae MH, Lee Y, Nam SO, Kim YM. Comparison of conservative therapy and steroid therapy for Bell's palsy in children. KOREAN JOURNAL OF PEDIATRICS 2018; 61:332-337. [PMID: 30304913 PMCID: PMC6212712 DOI: 10.3345/kjp.2018.06380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
Abstract
Purpose Bell’s palsy is characterized by sudden onset of unilateral facial weakness. The use of corticosteroids for childhood Bell’s palsy is controversial. This study aimed to identify clinical characteristics, etiology, and laboratory findings in childhood Bell’s palsy, and to evaluate the efficacy of corticosteroid treatment. Methods We conducted a retrospective analysis of children under 19 years of age treated for Bell’s palsy between January 2009 and June 2017, and followed up for over 1 month. Clinical characteristics, neuroimaging data, laboratory findings, treatments, and outcomes were reviewed. Patients with Bell’s palsy were divided into groups with (group 1) and without (group 2) corticosteroid treatment. Differences in onset age, sex, laterality, infection and vaccination history, degree of facial nerve palsy, and prognosis after treatment between the groups were analyzed. Results One hundred patients were included. Mean age at presentation was 7.4±5.62 years. A total of 73 patients (73%) received corticosteroids with or without intravenous antiviral agents, and 27 (27%) received only supportive treatment. There was no significant difference in the severity, laboratory findings, or neuroimaging findings between the groups. Significant improvement was observed in 68 (93.2%) and 26 patients (96.3%) in groups 1 and 2, respectively; this rate was not significantly different between the groups (P=0.48). Conclusion Childhood Bell’s palsy showed good prognosis with or without corticosteroid treatment; there was no difference in prognosis between treated and untreated groups. Steroid therapy in childhood Bell’s palsy may not significantly improve outcomes.
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Affiliation(s)
- Hye Won Yoo
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Lira Yoon
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Hye Young Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Kyung Hee Park
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Mi Hye Bae
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
| | - Yunjin Lee
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Yangsan, Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Yangsan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biochemical Research Institute, Busan, Korea
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Wolfovitz A, Yehudai N, Luntz M. Prognostic factors for facial nerve palsy in a pediatric population: A retrospective study and review. Laryngoscope 2016; 127:1175-1180. [PMID: 27641905 DOI: 10.1002/lary.26307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population. STUDY DESIGN Retrospective study. METHODS Sixty-seven pediatric patients (72 consecutive cases) diagnosed with and treated for FNP were divided into two severity subgroups. Associations between recovery in these groups and categorical variables were assessed using the Fisher exact test and for age using the t test. RESULTS Mean age on admission was 12.0 ± 4.5 years. Neither FNP outcome (graded by severity) nor improvement rates (expressed as the percentage of patients achieving a higher FNP grade over time) were influenced by gender, affected side, presence of polyneuropathy, etiology, or recurrent or familial FNP. In cases with comparable final outcome, improvement rates of those diagnosed with severe FNP on presentation (38.9% of cases) were significantly higher than mild-to-moderate FNP. Of the 47 patients who attended a follow-up examination 2 months after discharge, 70.2% have already recovered (by at least one House-Brackmann [H-B] grade) by the time they were discharged, whereas 90.9% achieved H-B grade ≤2, and 72.3% fully recovered (H-B grade 1) 2 months postdischarge. Adding antiviral medication did not affect FNP improvement rates or outcomes. CONCLUSIONS Rates of infectious and traumatic etiology in our patients were higher than reported for adults, but the most common etiology-as in those adults-was idiopathic. Routine extended diagnostic workup was not helpful, and antiviral medications were ineffective. The prognosis of FNP in pediatric patients is excellent, with 90% recovery by 2 months after initial presentation. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1175-1180, 2017.
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Affiliation(s)
- Amit Wolfovitz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noam Yehudai
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Luntz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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13
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Ciorba A, Corazzi V, Conz V, Bianchini C, Aimoni C. Facial nerve paralysis in children. World J Clin Cases 2015; 3:973-979. [PMID: 26677445 PMCID: PMC4677084 DOI: 10.12998/wjcc.v3.i12.973] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/04/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.
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Öztürk M, Siğirci A, Karadağ N. A rare cause of infant facial paralysis: atypical teratoid rhabdoid tumour located in the cerebellopontine angle. SPRINGERPLUS 2015; 4:729. [PMID: 26636017 PMCID: PMC4659804 DOI: 10.1186/s40064-015-1526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022]
Abstract
Atypical teratoid rhabdoid tumour (ATRT) is a rare malignant tumour of the central nervous system with embryonal roots. The majority are seen in early childhood and location is often in the posterior fossa. Surgery, radiotherapy and chemotherapy are used in treatment. Knowledge of the localisation of the mass preoperatively is necessary for direction of the chemoradiotherapy and sufficient resection in surgery. Differentiation from other brain tumours is important because of poor prognosis and differences in treatment. In this paper it was aimed to present the clinical and radiological findings of an ATRT located in the cerebellopontine angle, which occurred with facial paralysis.
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Affiliation(s)
- Mehmet Öztürk
- Diyarbakır Children's Hospital, 21100 Diyarbakır, Turkey
| | - Ahmet Siğirci
- Faculty of Medicine, Inonu University, Elazig road, 15 km, Malatya, Turkey
| | - Neşe Karadağ
- Faculty of Medicine, Inonu University, Elazig road, 15 km, Malatya, Turkey
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Abstract
The aim of this study is to evaluate the types and clinical characteristics of peripheral facial palsy in children. The hospital charts of children diagnosed with peripheral facial palsy were reviewed retrospectively. A total of 81 children (42 female and 39 male) with a mean age of 9.2 ± 4.3 years were included in the study. Causes of facial palsy were 65 (80.2%) idiopathic (Bell palsy) facial palsy, 9 (11.1%) otitis media/mastoiditis, and tumor, trauma, congenital facial palsy, chickenpox, Melkersson-Rosenthal syndrome, enlarged lymph nodes, and familial Mediterranean fever (each 1; 1.2%). Five (6.1%) patients had recurrent attacks. In patients with Bell palsy, female/male and right/left ratios were 36/29 and 35/30, respectively. Of them, 31 (47.7%) had a history of preceding infection. The overall rate of complete recovery was 98.4%. A wide variety of disorders can present with peripheral facial palsy in children. Therefore, careful investigation and differential diagnosis is essential.
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Affiliation(s)
- Unsal Yılmaz
- Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | | | - Tuba Sevim Yılmaz
- Department of Public Health, Dokuz Eylul University Hospital, Izmir, Turkey
| | | | | | - Orkide Güzel
- Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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Abstract
There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bell's palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bell's palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bell's palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bell's palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to "absence of evidence" rather than "evidence of absence."
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Affiliation(s)
- Abdul Qader Ismail
- Paediatric Department, Good Hope Hospital, Sutton Coldfield, Birmingham, England
| | - Oluwaseyi Alake
- Paediatric Department, Good Hope Hospital, Sutton Coldfield, Birmingham, England
| | - Chetana Kallappa
- Paediatric Department, Good Hope Hospital, Sutton Coldfield, Birmingham, England
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Abstract
Facial paralysis is a rare but severe condition in the pediatric population. Impaired facial movement has multiple causes and varied presentations, therefore individualized treatment plans are essential for optimal results. Advances in facial reanimation over the past 4 decades have given rise to new treatments designed to restore balance and function in pediatric patients with facial paralysis. This article provides a comprehensive review of pediatric facial rehabilitation and describes a zone-based approach to assessment and treatment of impaired facial movement.
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Youshani AS, Mehta B, Davies K, Beer H, De S. Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm. Emerg Med J 2013; 32:274-80. [PMID: 24317290 DOI: 10.1136/emermed-2013-202385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals. PATIENTS AND METHODS A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery. RESULTS The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals. CONCLUSIONS At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
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Affiliation(s)
- Amir Saam Youshani
- Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bimal Mehta
- Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Katharine Davies
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Helen Beer
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sujata De
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Özkale Y, Erol I, Yazıcı N. A germ cell tumor masquerading as Bell palsy. Pediatr Neurol 2013; 49:509-10. [PMID: 24095572 DOI: 10.1016/j.pediatrneurol.2013.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/16/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Yasemin Özkale
- Department of Pediatrics, Baskent University Faculty of Medicine, Adana, Turkey.
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Terzis JK, Konofaos P. Reanimation of facial palsy following tumor extirpation in pediatric patients: Our experience with 16 patients. J Plast Reconstr Aesthet Surg 2013; 66:1219-29. [DOI: 10.1016/j.bjps.2013.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/21/2012] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Bell's palsy in children: relationship between electroneurography findings and prognosis in comparison with adults. Otol Neurotol 2012; 32:1554-8. [PMID: 21997587 DOI: 10.1097/mao.0b013e31823556ae] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the correlation between electroneurography (ENoG) findings and the prognosis of Bell's palsy in children compared with adults. METHODS Twenty-two children and 92 adults with Bell's palsy who underwent ENoG between 8 days and 4 weeks from the onset of symptoms were retrospectively enrolled. The time to maximal recovery and rate of favorable recovery (House-Brackmann grade I or II) was assessed. Children (C) and adults (A) were further subdivided into low (<10%) or high (≧10%) subgroups according to their ENoG values (affected versus unaffected side) at initial evaluation. The numbers in each subgroup were as follows: C-low (n = 8), A-low (n = 21), C-high (n = 14), and A-high (n = 71). RESULTS Of the 22 children assessed, 2 of the 4 patients who showed a total loss of evoked potentials on the affected side (0% ENoG value) exhibited an unfavorable recovery. The remaining 20 patients achieved a favorable recovery eventually. Patients in group C-low reached a maximal recovery of facial movement significantly later than those in group C-high (p < 0.001). Time to maximal recovery of facial movement in group A-low was later than that in group C-low, although the difference was not statistically significant (p = 0.15). The patients in group A-high reached a maximal recovery significantly later than those in group C-high (p < 0.05). CONCLUSION Bell's palsy seems to recover earlier in children than adults when matched for severity. The presence of an identifiable response in ENoG, irrespective of its amplitude, may indicate a favorable recovery of facial movement in children.
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Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell's palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol 2012; 76:921-6. [PMID: 22503409 DOI: 10.1016/j.ijporl.2012.02.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To conduct an updated systematic review on the outcome of Bell's palsy (BP) in children following steroid treatment. DATA SOURCES MEDLINE, EMBASE, Cochrane Library and BIOSIS Previews electronic databases were searched obtaining articles published between 2000 and 2010 without any language restriction. REVIEW METHODS Articles describing children aged 0-18 years with BP treated solely with corticosteroids were included. In studies including various etiologies for facial palsy; cases of BP treated with steroids were selected and when available, untreated patients as well for comparison. The outcome measure was facial movements following steroidal treatment based on different clinical scales. Controlled clinical trials, prospective and historical cohort studies, cross sectional studies and case series were included. RESULTS A total of 2293 papers were initially identified. Following review by two authors, 68 papers were analyzed in a hard-copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies included children with BP exclusively while the remaining studies described various etiologies of facial palsy. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House-Brackmann scale, Yanagihara grading system and clinical evaluation. Studies analyzed were retrospective cohorts or case-series and were categorized as level 4 of evidence. CONCLUSION There were no controlled trials and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.
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Affiliation(s)
- Jacob Pitaro
- Division of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Galli-Tsinopoulou A, Kyrgios I, Giannopoulou EZ, Gourgoulia S, Maggana I, Katechaki E, Chatzidimitriou D, Evangeliou AE. Acquired toxoplasmosis accompanied by facial nerve palsy in an immunocompetent 5-year-old child. J Child Neurol 2010; 25:1525-8. [PMID: 21148450 DOI: 10.1177/0883073810370480] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquired toxoplasmosis, although relatively common in children, is usually asymptomatic but can also be clinically manifested by a benign and self-limited infectious mononucleosis-like syndrome. Neurological complications are very rare in immunocompetent children. The authors report a 5-year-old boy who presented with cervical lymphadenopathy because of acquired toxoplasmosis accompanied with unilateral facial nerve paralysis. Toxoplasma gondii DNA detection in blood by polymerase chain reaction, as well as elevated specific immunoglobulin M antibodies against it, established the diagnosis. Characteristic brain lesions on magnetic resonance imaging were absent and ophthalmologic examination revealed no inflammatory lesions in the retina and choroid. Treatment with pyrimethamine, sulfadiazine, and folic acid resulted in a complete recovery after 2 months of therapy. Although rare, acute facial nerve paralysis of unknown origin can be caused by acquired toxoplasmosis even in the immunocompetent pediatric population. Elevated titers of specific antibodies and the presence of parasite's DNA are key findings for the correct diagnosis.
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Affiliation(s)
- Assimina Galli-Tsinopoulou
- Department of Pediatrics, Medical School, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece.
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