Key Lessons in Managing Pediatric Neoplastic Facial Paralysis

Pediatric neoplastic facial paralysis presents challenges in planning surgical reanimation.

A review of pediatric patients with facial paralysis secondary to malignant tumors was conducted. Oncological data, functional status, chronology, and degree of paralysis were recorded. Surgical indications and techniques were documented. Postoperative outcomes included facial nerve function and survival.

A total of 14 patients were analyzed. The most common tumor location was the posterior fossa (n = 12). Most patients showed stability of the tumoral disease (n = 11). Facial paralysis occurred mainly after tumor surgery (n = 12). The House-Brackmann (HB) grade at diagnosis was IV (n = 2), V (n = 3), and VI (n = 7). Two patients had bilateral paralysis, with HB grade V (n = 1) and VI (n = 1) respectively. Facial reanimation was performed on 10 patients, with a median paralysis-to-surgery interval of 15 months (2-21). Surgical techniques included interposition nerve grafts, cross-facial nerve grafts, or regional nerve transfers. At 12 months, 9 patients improved to HB grades III-IV, the Sunnybrook score improving from 7.5 (5-55) to 44 (34-67). The deaths of 3 patients were documented. The remaining patients maintained stable facial function.

Our experience with facial reanimation surgery in oncological patients is positive, most patients remaining with stable oncological status and good functional outcomes.