Facial Nerve Paralysis in a School boy. A Case Study

Introduction: Bell’s palsy is defined as the acute unilateral lower motor neuron paralysis of the facial nerve with a prevalence of 2.7/100.000 below the age of ten. The pathogenesis is uncertain but an autoimmune, demyelinating mechanism is postulated triggered by infections, toxins and metabolic diseases. Tumors, skull base fractures and iatrogenic sequelae after brain surgery must be ruled out.

Objectives: We present the case of an 8 year old patient with facial nerve paralysis with a good outcome.

Materials-Methods: An 8 year old boy was brought in the paediatric emergency department due to a sudden painful right facial droop, 12 hours after mild brain trauma while exercising at home. Clinical evaluation revealed a House Brackman grade III right facial palsy. The patient couldn’t wrinkle the forehead, taste, grimace, blink and fully close the eye from the affected side. He was investigated with blood work, brain CT, ophthalmology and audiology review. Viral tests were negative, imaging of the brain revealed no identifiable skull fracture and ophthalmology examination demonstrated ptosis of the right eyelid, lacrimation and established keratitis. Audiological evaluation confirmed the presence of stapedial reflexes and proved that hearing was not influenced. The patient delivered treatment with acyclovir and prednisolone, local eye care with karbomer gel, as well as immediate physiotherapy and electrotherapy. He demonstrated gradual functional and aesthetical improvement within 72 hours and his follow up, a month later, was excellent.

Conclusion: While there is evidence of quick recovery in adults with facial nerve palsy when treated with steroids, similar studies in children are not adequate. Early targeted physiotherapy and electrotherapy can boost functional recovery. High level randomised controlled trials in paediatrics with steroids+/- acyclovir are required in order to demonstrate clear evidence of benefit of these agents in the paediatric population.