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Facial nerve palsy in a child: Bell's palsy? Think again!
J E Sam1, S Priya2, A W Nasser3
1(Corresponding author) MD UKM Penang General Hospital, Jalan Residensi 10990 Penang, Malaysia
Insights
A rare sphenoid wing meningioma caused facial paralysis in a child. Early diagnosis through meticulous examination is crucial, as idiopathic causes are often presumed.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Craniofacial Surgery
Background:
- Facial paralysis in children is often presumed idiopathic, but serious underlying conditions can be missed.
- Thorough clinical evaluation is essential to avoid misdiagnosis of pediatric facial nerve palsy.
Observation:
- A 4-year-old girl presented with facial asymmetry, initially suggestive of upper motor neuron facial nerve palsy.
- Magnetic resonance imaging (MRI) revealed a sphenoid wing meningioma as the cause.
Findings:
- The sphenoid wing meningioma was successfully excised via craniotomy.
- Histopathology confirmed a grade 1 transitional meningioma, a rare tumor in pediatric patients.
Implications:
- This case highlights the importance of considering structural lesions in pediatric facial paralysis.
- Delayed presentation in children necessitates a high index of suspicion for underlying pathologies.
- Accurate differentiation between upper and lower motor neuron patterns is vital for management decisions.
Introduction:
Half of facial paralysis in children is idiopathic at origin. However, dismissing facial paralysis as being idiopathic without a thorough history and meticulous examination could be disastrous as illustrated by this case.
Case Report:
We report a case of sphenoid wing meningioma in a 4-year-old girl. She first presented with only facial asymmetry that was noticed by her mother. Examination suggested a left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision. Histopathological examination of the tumour showed a grade 1 transitional type meningioma. Meningiomas in children are rare compared to the adult population. Presentations in children may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis in children.