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Acute Facial Nerve Palsy in Children: Gold Standard Management
Delphine Wohrer1, Thomas Moulding2, Luigi Titomanlio1,3,4
1Department of Paediatric Emergency Care, APHP-Hôpital Robert Debré, 75019 Paris, France.
Insights
Facial nerve palsy (FNP) in children requires prompt diagnosis to prevent long-term issues. While Bell's palsy often needs no further tests, other cases require investigation and tailored treatment for good recovery outcomes.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Ophthalmology
Background:
- Facial nerve palsy (FNP) is a frequent diagnosis in pediatric emergency settings.
- Delayed diagnosis of FNP can significantly impair a child's quality of life.
Purpose of the Study:
- To provide a current overview of pediatric FNP, covering causes, diagnosis, red flags, investigations, and management.
- To highlight the need for further research in pediatric FNP.
Main Methods:
- Literature review of recent studies on pediatric facial nerve palsy.
- Analysis of diagnostic criteria and treatment protocols.
- Evaluation of recovery rates and outcomes in children.
Main Results:
- Acquired, acute-onset, isolated FNP in children may indicate Bell's palsy, often requiring no further investigation.
- Other FNP presentations necessitate complementary examinations to determine etiology.
- Corticosteroids and antivirals are suggested for suspected viral Bell's palsy, though pediatric evidence is limited.
Conclusions:
- Children with FNP generally exhibit excellent recovery rates, regardless of treatment.
- Further randomized controlled trials are crucial to optimize treatment strategies for pediatric FNP.
- Early and accurate diagnosis is paramount for managing FNP in children effectively.
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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Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...