Facial paralysis in children. A review of 150 cases.

Abstract

AbstractThe in‐patient records at the Hospital for Sick Children were reviewed for the 10‐year period 1960 to 1970. All charts in which were coded a primary diagnosis of Bell's palsy, facial paralysis or paresis, or a secondary diagnosis of facial nerve functional disturbance were pulled and reviewed. As there was no out‐patient diagnostic index in that period, it proved impossible to identify the numbers or diagnosis of patients with the physical sign of those who were not admitted to the hospital.There were 150 patients in whom a facial nerve disorder was recorded. The distribution and a broad etiological classification is shown in Table I. It will be seen that there were significantly more lower motor neurone than upper motor neurone lesions, although it is likely that many upper motor neurone facial pareses were not recorded because they formed but a small part of a more serious generalized neurological disorder.The upper motor neurone pareses which were recorded had a variety of causes. The infections included meningitis and Guillain‐Barré syndrome. Three of the four infective cases made a complete recovery, as did all of the traumatic cases. In one of the hydrocephalic children the facial paresis diminished as the primary lesion responded to treatment. The presence of an upper motor neurone facial paresis is therefore not necessarily a sign of irreversible disease.Trauma due to birth injury, accident or motor vehicle injury was the most common cause of lower motor neurone paresis. The birth injuries usually cleared spontaneously. Bell's palsy was the next most common cause of facial palsy. The sexes were equally affected and the age distributions even throughout childhood. Bell's palsy in children, as in adults, may not clear spontaneously, and should be treated with respect.Facial palsy caused by acute inflammatory disease responds in most instances to antibiotic treatment, although simple mastoidectomy may be necessary. The outcome in this group is excellent. The remarkably few cases of facial palsy complicating chronic middle ear disease are a reflection of the changing pattern of disease.Operative causes were surprisingly mainly due to parotid surgery, and the indication for surgery was always excision of parotid hemangioma. In a 10‐year period there were only two facial palsies attributable to temporal bone surgery.There is a need for a detailed prospective study of all children with a facial paralysis and particularly the Bell's palsy group. Only in this way will accurate figures be obtained about the prognosis and thus allow appropriate regimens to be established.