The Treatment Strategy for Peripheral Facial Nerve Palsy in Children

Statistical analysis was undertaken for 30 cases of peripheral facial nerve palsy in patients under the age of 15 years-old treated in Oita University Hospital between January 1981 and December 2003. Diagnoses were: Bell's palsy (n=14), Hunt's syndrome (n=7), otitis-related palsy (n=8), and traumatic palsy (n=1). This paper reports the results of treatment with particular regard to Bell's palsy and Hunt's syndrome.Successful management of facial palsy requires confident and accurate diagnosis, reliable estimation of prognosis, and effective treatment. In children, however, it is difficult to evaluate the degree of facial palsy and to select an adequate therapeutic protocol. In our department, most patients were treated with steroids after informed consent was obtained from the parents.On follow-up after 180 days, the complete recovery rate for Bell's palsy was 11 of 11 cases (100%) while that for Hunt's syndrome was 3 of 7 cases (42.9%). The final recovery rate was thus significantly higher for Bell's palsy than for Hunt's syndrome. For Bell's palsy, the recovery rate was better in children than in adults (55/68, 80.9%); however, that for Hunt's syndrome was worse in children than in adults (22/29, 75.9%).Electroneurography (ENoG) was performed in 17 patients with Bell's palsy or Hunt's syndrome and the results corresponded with clinical outcome. Vestibular function testing was performed in 19 patients, and demonstrated ipsilateral canal paralysis (CP) in 2 cases, both of which were diagnosed as having Hunt's syndrome with poor clinical outcome. From the above results, it was concluded that CP on vestibular function testing suggests a poor prognosis.