Etiologies, periocular manifestations and surgeries for congenital and childhood acquired facial nerve palsy

Abstract

To report periocular surgeries performed for patients with congenital and childhood acquired facial nerve palsy (FNP). A retrospective case series of pediatric patients who presented with FNP over the last 34years, was conducted at two tertiary eye hospitals in Riyadh. Data were collected from electronic charts, hospital records and external photos. Main outcome measures were visual acuity, lagophthalmos, eyelid abnormalities, Bell's phenomena, exposure keratopathy, and corneal scar; in these cases, periocular surgeries were required. Among the 90recruited subjects; the mean age of onset was 4.8±5.4years old (range, 0.01 to 17.76years). Traumatic and congenital causes of FNP were the most common, representing over 80% of the cases. Seventy-one patients developed lagophthalmos, 26 with severe exposure that resulted in scarring. Thirty-six (40%) cases had associated strabismus. Lower lid retraction was the most common eyelid abnormality noted in 23cases, followed by entropion in 16 and ectropion in 6cases. Temporary tarsorrhaphy was performed in three patients (3.3%), while 18patients (20%) needed permanent tarsorrhaphy. Gold weight implants were placed in 17patients (18.9%). Lower lid retraction repair was performed in twelve patients (13.3%). Five patients (5.6%) underwent lower eyelid entropion repair, and three patients (3.3%) underwent lower eyelid ectropion repair. Lagophthalmos is the most common finding in children presenting with FNP and needs to be managed early to prevent permanent visual loss. Compared to adults, children may present with a different spectrum of eyelid abnormalities, with lower lid retraction and entropion being the most common eyelid malpositions.