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.
Highlights
Facial nerve palsy is a frequent presentation in paediatric accident and emergency departments and, given its abrupt onset and often rapid progression, requires prompt diagnosis to limit the impact on morbidity and quality of life of patients [1].To understand the pathophysiology of facial paralysis, it is essential to know the anatomy of the facial nerve
The prevalence rate of Bell’s palsy is debated; a retrospective study by Yilmaz et al included 81 children diagnosed with peripheral facial palsy in a Turkish hospital between 2011 and 2013 and reported an idiopathic cause rate of 80.2% [11]
This is coherent with a retrospective study by Shih et al, who observed an idiopathic cause in Children 2022, 9, 273
Summary
Facial nerve palsy is a frequent presentation in paediatric accident and emergency departments and, given its abrupt onset and often rapid progression, requires prompt diagnosis to limit the impact on morbidity and quality of life of patients [1]. The posterior auricular nerve, which provides the motor innervation around the ear, is the first extracranial branch of the facial nerve. Bell’s palsy is the idiopathic form of FNP, described in 1830 by Sir Charles Bell It is an acquired, idiopathic facial palsy characterised by a palsy or weakness of facial muscles, usually on one side, with no obvious cause. Idiopathic facial palsy characterised by a palsy or weakness of facial muscles, usually on one side, with no obvious cause This corresponds pathologically to symptoms including immobility of the brow, incomplete lid closure, drooping of the corner of the mouth, impaired closure of the lips, dry eye, hyperacusis, impaired taste, and pain around the ear [3]. In this narrative review, we will present the paediatric causes of FNP and their epidemiology, delineate how to accurately diagnose patients and provide an overview of the current treatments commonly used in the management of FNP
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