Facial Nerve palsy in children

Incidence of neonatal facial nerve palsy: 0.25%

80% are caused by facial trauma during delivery

Congenital

Mononeural agenesis
Congenital facial paralysis
Congenital unilateral lower lip palsy

Facial paralysis with other deficits

Möbius' syndrome (VI, VII, bilateral)
Hemifacial microsomia
Oculonuriculovertebral dysplasia
Poland's syndrome (agenesis pectoralis major muscle)

Secondary to teratogens
Thalidornide
Rubella
Dystrophic dystonia

Acquired

Birth trauma
Forceps injury
Pressure from maternal sacrum
Pressure from fetal shoulder
Intracranial hemorrhage
Idiopathic
Bell's pulsy
Systemic or infectious disease
 Melkersson-Rosenthal syndrome
Poliomyelitis
Infectious mononucleosis
Varicella
Acute otitis media
Meningitis

Few Notes:

Congenital unilateral lower lip palsy

 Absence of depressor labii inferioris muscle activity

 It is associated with a lesion of the brainstem
Mobis: may be also ass with EAC anomalies

Nerve palsy is due to underdevelopment of the nerve

Optimal rehabilitation by free muscle transposition

Melkersson's Syndrome

Triad of:

1. facial paralysis
2. orofacial swelling mainly upper lip (defining feature)
3. fissured tongue

Idiopathic

Diagnosis:

Lip biopsy shows lymphatic edema and granulomatous dx with giant cells

May have elevated level of ACE during the attack

 Paralysis may be recurrent/ bilateral

 Treatment is the same as for Bell's palsy.

Osteopetrosis (albers-schoberg disease-marble bone disease)

 AR
 Conductive due to ossicles involvement/mixed hearing
loss
 Sclerotic brittles bone due to failure to resorb calcified
bone
 Increased incidence of osteomyelitis
 Choanal atresia
 Atresia of the para nasal sinus
 Optic atrophy
 Fluctuating facial nerve palsy
 Cranial nerve II,V,VII

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