PEDIATRIC SURGERY UPDATE ©

VOL 33 NO 02 FEBRUARY 2010

Bell's Palsy

Bell's palsy is an acute idiopathic paralysis of the VII cranial nerve (facial nerve) resulting in inability to control facial muscles on the affected side. Bell's palsy  is a non life-threatening disorder that can cause significant impact in the life of the child. Other conditions that can cause fascial paralysis include brain tumor, head trauma, meningitis and Lyme's disease. The mean age of involvement is eight years with a similar sex predilection. It is thought that an inflammatory condition leads to swelling of the facial nerve and compression in the narrow bone canal leading to nerve inhibition, damage or death. No readily identifiable cause for Bell's palsy has been found, though acute immune demyelination triggered by a viral infection may be responsible. The school nurse may be the first person to assess facial palsy and muscle weakness in children. Careful diagnosis and workup using head CT and MRI is warrant in all cases to exclude other serious causes of fascial paralysis. MRI enhancement of the distal intrameatal and labyrinthine segments of the nerve canal are specific for facial nerve palsy. Complete spontaneous recovery is seen in almost 70% of patients within six weeks of onset, but up to 30% have delayed or incomplete recovery. Use of steroid or antiviral therapy is controversial since most children recover without treatment. Physiotherapy, in the form of transcutaneous peripheral nerve stimulation, has an important role.

References:
1- Kinoshita T, Ishii K, Okitsu T, Okudera T, Ogawa T: Facial nerve palsy: evaluation by contrast-enhanced MR imaging. Clin Radiol. 56(11):926-32, 2001
2- Dhiravibulya K: Outcome of Bell's palsy in children. J Med Assoc Thai. 85(3):334-9, 2002
3- Singhi P, Jain V: Bell's palsy in children. Semin Pediatr Neurol. 10(4):289-97, 2003
4- Atzema C, Goldman RD: Should we use steroids to treat children with Bell's palsy? Can Fam Physician. 52:313-4, 2006
5-Shih WH, Tseng FY, Yeh TH, Hsu CJ, Chen YS: Outcomes of facial palsy in children.Acta Otolaryngol. 15:1-6, 2008
6- Gordon SC: Bell's palsy in children: role of the school nurse in early recognition and referral. J Sch Nurs. 24(6):398-406, 2008

*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
P.O. Box 10426, Caparra Heights Station, San Juan, Puerto Rico 00922-0426
Tel (787)-786-3495 Fax (787)-720-6103 E-mail: TITOLUGO@COQUI.NET
Internet Address:HTTP://HOME.COQUI.NET/TITOLUGO
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Pediatric Surgery Update ISSN 1089-7739
Last updated: March 2010