Review article Facial nerve palsy in childhood Evangelos Pavlou ⇑ , Anastasia Gkampeta, Maria Arampatzi 2nd Department of Pediatrics, Aristotle University of Thessaloniki, ‘AHEPA’ General Hospital, Thessaloniki, Greece Received 2 September 2010; received in revised form 9 November 2010; accepted 10 November 2010 Abstract Facial nerve palsy in children is usually idiopathic but can also result from many conditions such as neoplasias, systemic diseases, or congenital anomalies with poor prognosis. Children with idiopathic facial palsy (Bell’s palsy) have a very good prognosis, while treatment with prednisone does not certainly improve the outcome. The causes of facial nerve palsy in childhood differ from those in adults. A detailed investigation and differential diagnosis are recommended for facial palsy in children. Ó 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved. Keywords: Facial palsy; Idiopathic; Children 1. Introduction – epidemiological data Facial nerve palsy is a common malady with severe con- sequences in patients’ quality of life. An estimated 15–40 per 100,000 people per year are affected by facial nerve palsy [1]. The most common cause of unilateral facial palsy is Bell’s palsy, also known as idiopathic facial palsy. The lowest incidence of Bell’s palsy is found in persons younger than 20 years old, while the highest incidence in persons aged 60 years or older. There seems to be a correlation between the age and incidence of Bell’s palsy. The inci- dence in patients older than 10 years is 2.7/100,000, while in patients between 10 and 20 years old is approximately 10.1/100,000 [2,3]. There are insufficient studies concerning young children and infants with Bell’s palsy, so the data about causes, treatment and prognosis are poor, in con- trast to them concerning adults with Bell’s palsy. 2. Neuroanatomy The facial nerve (7th of 12 paired cranial nerves) emerges from the brainstem between the pons and the medulla, and enters the petrous portion of the temporal bone via the internal auditory canal. On its course, facial nerve approaches tympanic cavity and stylomastoid foramen, providing parasympathetic fibers to the sub- mandibular gland and sublingual glands via chorda tympani. It also supplies parasympathetic innervations to the nasal mucosa and the lacrimal gland and also receives taste sensation from the anterior two-thirds of the tongue. The facial nerve exits the skull through the stylomastoid foramen and terminates into the zygomatic, buccal, mandibular and cervical branches. The examination of patients with Bell’s palsy demon- strates flattening of the forehead and nasolabial fold on the side affected with the palsy, eyebrow sagging, inability to close the eye and the mouth drawn to the non-affected side. Difficulties in feeding and speech, hyperacusis, lack of taste, lacrimation, and sialorrhea are also present. So, it is a complicated condition affecting basic functions with psychological and cosmetic complications. 3. Differential diagnosis Idiopathic facial nerve palsy (or Bell’s palsy) is less common in younger children and infants than it is in teenagers and adults. Other conditions such as infections, inflammatory conditions, injuries, neoplasias, 0387-7604/$ - see front matter Ó 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2010.11.001 ⇑ Corresponding author. Address: Elaiones Pilaias, Thessaloniki 55535, Greece. Tel.: +30 2310994815; fax: +30 2310993514. E-mail address: eepav@yahoo.gr (E. Pavlou). www.elsevier.com/locate/braindev Brain & Development 33 (2011) 644–650