Facial nerve paralysis in children

Table 1 Possible causes of facial nerve palsy in children

Causes of facial nerve palsy in childhood
Idiopathic	Bell’s palsy
Congenital	Delivery traumas:
	Primiparity
	Birth weight > 3500 g
	Forceps
	Cesarean section
	Prematurity
	Syndromic malformative:
	Möbius syndrome
	Goldenhar syndrome
	Syringobulbia
	Arnold-Chiari syndrome
	Genetic:
	Hereditary myopathies
	3q21-22 and 10q21.3-22.1 mutations
Acquired	Infectious:
	Ramsay Hunt syndrome
	Epstein-Barr virus
	Haemophilus influenzae
	Tubercolosis
	Lyme disease
	Cytomegalovirus
	Adenovirus
	Rubella
	Mumps
	Mycoplasma pneumoniae
	Human immunodeficiency virus
	Acute otitis media
	Chronic otitis media/cholesteatoma
	Inflammatory:
	Henoch-Schönlein porpora
	Kawasaki syndrome
	Neoplastic:
	Schwannomas of the VII c.n.
	Hemangiomas
	Rhabdomyosarcoma
	Temporal bone histiocytosis
	Leukemia
	Parotid gland tumors
	Traumatic:
	Temporal bone fractures
	Iatrogenic

Table 2 Therapeutic approaches to facial nerve palsy in childhood

Therapy of facial nerve palsy		Outcome1
Drugs	Bell’s palsy
	Oral steroids within 3 d of onset	70% recovery after 3 wk[32]
	Ramsay Hunt syndrome
	Intravenous steroids as soon as possible	75% recovery at 6 mo if treated within 3 d from onset; 30% recovery at 6 mo if treated after 7 d from onset[36,44]
	Antiviral agents
	Other conditions
	Targeted therapies for specific diseases	N/A
Protective measures	Eye protection	N/A
	Artificial tears	N/A
	Tarsorrhaphy	N/A
	Eyelid weight implant	N/A
	Nutritional support	N/A
Surgery	Traumatic palsy
	Neurorrhaphy within 72 h	N/A
	Nerve grafting within 72 h	N/A
	Other conditions
	Dynamic facial reanimation
	Temporalis elongation mioplasty	80% recovery within 1 mo[38]
	Gracilis muscle microvascular free flap	89% recovery within 4-6 mo[45]
	Sural nerve grafting	N/A
	Cross-facial nerve grafting	83% recovery within 1 yr[46]
Rehabilitation approaches	Botulinum toxin	100% recovery (temporary)[24]
	Physiotherapy	N/A
	Biofeedback therapy	N/A
Regenerative therapy	Bioelectrical interface/electrode	N/A
	Stem cells and bio-scaffolds	N/A

¹When available.