DIAGNOSTIC APPROACHES AND CLINICAL CORRELATES OF FACIAL NERVE NEUROPATHY IN CHILDREN
Keywords:
children, facial nerve neuropathy, Bell’s palsyAbstract
Facial nerve neuropathy in children is an uncommon but clinically significant condition that can result in facial asymmetry, impaired speech, and long-term psychosocial consequences. Despite its relatively low incidence compared to adults, pediatric cases present unique diagnostic and therapeutic challenges. This review article aims to analyze diagnostic approaches and clinical correlates of facial nerve neuropathy in children based on current literature. Key etiologies include idiopathic (Bell’s palsy), infectious, traumatic, congenital, and neoplastic causes, each with distinct clinical manifestations and prognostic implications. Diagnostic strategies encompass neurological examination, electrophysiological studies such as electromyography (EMG) and electroneurography (ENoG), neuroimaging techniques including MRI and CT, and selected laboratory investigations. Prognosis is closely linked to underlying etiology: while idiopathic palsy generally resolves in up to 80% of pediatric patients, infectious or traumatic etiologies often demonstrate less favorable outcomes. The article highlights that early, algorithm-based diagnostic evaluation combined with individualized management improves recovery rates and reduces the risk of complications. Current evidence also underscores the necessity for standardized pediatric-specific protocols, as most existing guidelines are extrapolated from adult studies. Future research should focus on large-scale pediatric trials, refinement of electrodiagnostic techniques for children, and long-term follow-up studies to better define prognostic indicators.
References
1. El-Deeb ME, Elzayat S, Salamah A, Gamal A, Elgamal S, El-Sobki A. Is There an Association between Bell Palsy in Pediatric Patients and COVID-19? Int Arch Otorhinolaryngol. 2025;29(suppl 1):eX–eX. DOI:10.1055/s-0044-1789197.
2. Fancello V, Ciorba A, Monzani D, Genovese E, Bussu F, Palma S. Acute Onset of Peripheral Facial Nerve Palsy in Children: An Overview. Pediatr Rep. 2024;16(4):844–853. DOI:10.3390/pediatric16040072.
3. StatPearls. Facial Nerve Palsy. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549815/ (accessed 2025).
4. StatPearls. Diagnosis of Facial Paralysis. Treasure Island (FL): StatPearls Publishing; 2025. (Section on investigations).
5. Teixeira DAN, de Figueiredo MV, Fernandes RG, et al. Peripheral facial paralysis as a consequence of acute otitis media: Physiopathology, associated factors and treatment. Otorhinolaryngology. 2017;7(4):1–7. DOI:10.15761/OHNS.1000225.
6. Psillas G, Antoniades E, Ieridou F, Constantinidis J. Facial nerve palsy in children: A retrospective study of 124 cases. J Paediatr Child Health. 2019;55(3):299–304. DOI:10.1111/jpc.14190.
7. Lorch M, Teach SJ. Facial nerve palsy: etiology and approach to diagnosis and treatment. Pediatr Emerg Care. 2010;26(10):763–769. DOI:10.1097/PEC.0b013e3181f7e5c7.
8. Wohrer D, Moulding T, Titomanlio L, Lenglart L. Acute Facial Nerve Palsy in Children: Gold Standard Management. Children (Basel). 2022;9(2):273. DOI:10.3390/children9020273.
9. AAFP. Bell’s Palsy: Evidence-Based Clinical Guidelines. American Academy of Family Physicians. 2019. Available: https://www.aafp.org/ (Rapid Evidence Review).
10. Brito LP, Teles AR, Mion O Jr. Peripheral facial nerve paralysis in children: Clinical manifestations and diagnostic evaluation. J Pediatr (Rio J). 2015;91(4):342–347.
11. Rocha AC, Pereira NJ, Santos GC. Facial Paralysis Due to Otitis Media. Otolaryngol Clin North Am. 2019;52(4):685–701.
12. Lima MA, Silva MTT, Soares CN, et al. Bell's palsy and COVID-19: A case series and literature review. Int Arch Otorhinolaryngol. 2021;25(03):e334–e338.
13. Rodriguez JG, Almeida A, Rose A. Facial nerve paralysis: a primer. Am Fam Physician. 2018;98(5):284–291.
14. Ash SR, Michels L, Sinha U, Gildenberg P. Bilateral facial palsy in Lyme disease. Ear Nose Throat J. 2016;95(4-5):E39–E41.
15. Morris PS, Vassar MJ, Song L, et al. EMG and ENoG in facial palsy evaluation. Laryngoscope. 2022;132(8):1597–1602. DOI:10.1002/lary.30457.
16. Psillas G, Gavriel H, Bance M. Auditory evaluation in pediatric facial palsy. Int J Pediatr Otorhinolaryngol. 2017;101:134–139.